Total knee arthroplasty (TKA) is the most performed operating room procedure in the United States, and the number of surgeries is projected to increase by 400% (to 3.5 million a year) in the next twenty years due to prolonged longevity, the rise in obesity, and increasing rates of osteoarthritis. The surgery itself traumatizes the surrounding tissues resulting in significant whole leg swelling that increases by 10% per day for the first three days after surgery, reaching an average peak increase of 35% within six-to-eight days. The swelling overloads the lymphatic system, and the increase in pressure results in joint and soft tissue tightness, tension, and pain, which restricts venous blood return to the heart. Post-operative swelling after TKA may persist for six months or longer causing multiple functional deficits including (but not limited to) reduced strength, decreased range of motion (ROM), and slower walking speeds. Can chiropractic care play a role in a TKA patient’s post-surgical care plan?
A March 2022 study set out to determine the benefits of a multimodal swelling intervention during the three weeks following TKA that includes the use of an inelastic adjustable compression garment (CG), manual lymph drainage (MLD) massage, and a home exercise program (HEP). The researchers assessed the participants at six time points (day 1, day 4, day 7, day 14, day 21, and day 42, which is three weeks after the conclusion of the treatment period). Their assessments measured patient satisfaction, safety, patient adherence, and swelling (using device called a Single Frequency Bioimpedance Analysis).
The results showed an overall patient satisfaction rate of 93% with no adverse side effects noted. The research team also noted very high adherence rates for each of the three treatments (CG – 85%, MLD – 99%, and HEP – 97%), but most importantly, swelling reduced throughout the treatment period with minimal change in swelling at the day 42 follow-up. This is encouraging as swelling is the leading cause of emergency room visits within 30 days post-op, and it also increases the risk of blood clots (deep vein thrombosis or DVT), infection, delayed wound healing, and often interferes with post-surgical rehabilitation.
Doctors of chiropractic utilize lymphatic drainage manual therapies, massage, and other soft tissue therapy. They’re also known to prescribe home exercise programs as part of a treatment plan. Additional services that may benefit the post-TKA patient include spine, pelvic, and extremity manipulation/mobilization, muscle balancing techniques, as well as modality use, nutritional counseling, activity modification recommendations, and orthotic prescriptions to address leg length variance, which can occur post-TKA. These are particularly important as the altered gait pattern that is common post-TKA often results in the development of faulty movement patterns that can have a significant impact on quality of life and may delay recovery.