title: Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial.
abstract: To evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA).
  
  
  
  Randomized controlled trial.
  
  
  
  Primary care hospital.
  
  
  
  Two groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m(2)).
  
  
  
  Participants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery.
  
  
  
  Swelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters.
  
  
  
  At seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (-2.6°; 95% confidence interval, -5.0° to -0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%-52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments.
  
  
  
  MLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.
authors.affiliation: Physiotherapy Department, University of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland; Orthopedics and Traumatology Department, University Hospital of Lausanne - University of Lausanne, Lausanne, Switzerland. Electronic address: claude.pichonnaz@hesav.ch.
authors.forename: Claude
authors.initials: C
authors.lastname: Pichonnaz
authors.affiliation: Physiotherapy Department, University of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Bassin
authors.affiliation: Medical Direction, University Hospital of Lausanne - University of Lausanne, Lausanne, Switzerland.
authors.forename: Estelle
authors.initials: E
authors.lastname: Lécureux
authors.affiliation: Physiotherapy Department, University of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Christe
authors.affiliation: Physiotherapy Department, University of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
authors.forename: Damien
authors.initials: D
authors.lastname: Currat
authors.affiliation: Laboratory of Movement Analysis and Measurement, Swiss Institute of Technology of Lausanne, Lausanne, Switzerland.
authors.forename: Kamiar
authors.initials: K
authors.lastname: Aminian
authors.affiliation: Orthopedics and Traumatology Department, University Hospital of Lausanne - University of Lausanne, Lausanne, Switzerland.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Jolles
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000534:rehabilitation*; D058266:Dielectric Spectroscopy / Q000379:methods; D004322:Drainage / Q000379:methods*; D004487:Edema / Q000209:etiology / Q000628:therapy*; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007719:Knee Joint; D008221:Lymphoid Tissue / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D011184:Postoperative Period; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome
keywords: Arthroplasty; Edema; Knee joint; Physical therapy specialty; Rehabilitation; Treatment outcome