Adoption of a total knee arthroplasty (TKA) multimodal post-operative swelling intervention protocol shows significant reduction in single-frequency bioimpedance (SF-BIA) values: a pilot study

Introduction Post-operative dissatisfaction is often multifactorial with patients citing continued pain, decreased mobility, limited improvement in knee function and chronic swelling to be among the most common complaints. Acute tissue swelling after TKA can lead to overall patient discomfort, decreased joint range of motion (ROM), while lengthening the post-op recovery period. The purpose of this study was to compare patient outcome measures after the addition of an intraoperative anti-inflammatory bactericidal rinse, a post-operative cryocompression device, extended length oral tranexamic acid, and edema-controlling stockinette to previously published control group data. Methods This non-concurrent cohort study was conducted to measure the effects of peri-operative treatment algorithms on post-operative swelling in patients undergoing TKA. All TKA procedures were conducted by a single surgeon. All patients in the multimodal arm of the study received the same swelling reduction interventions as the control group in a previously published preoperative care protocol. In addition, the multimodal group had four other interventions: intraoperative anti-inflammatory bactericidal irrigation solution, post-operative cryocompression, extended length oral tranexamic acid (1300mg daily for 15 days), and a specific edema-controlling stockinette. Statistical analysis was performed for single-frequency bioimpedance (SF-BIA) measurements between groups pre-op, and at 7-, 14-, 21-, and 42- postoperative days. Results Twenty-four subjects in the multimodal group were compared to published data on 30 participants in the control group. The multimodal group showed significantly better SF-BIA measurements compared to control at 7 days and 14 days (p=p= 0.0054 and 0.0036). With the numbers available, there was no significant difference found at 21- or 42- days. Conclusion This pilot feasibility study was conducted to collect data to assist in powering a future larger cohort trial. The results suggest that the multimodal swelling protocol is better at reducing early postoperative swelling than conventional treatment. Other studies are needed to evaluate the contribution of each component of this multimodal protocol to reducing swelling after TKA.