REDUCING OEDEMA, HOSPITAL STAYS, AND READMISSION IN THE ORTHOPAEDIC POPULATION

Over 25,000 hip and knee replacements (THR TKR) are performed in Ontario each year, and the impact of an emergency department (ED) presentation rate of 15% or 1 in 7 patients within 30 days of surgery is considerable.1 In a US analysis, 2344 THR and 5520 TKR surgeries between 2012 and 2015 were reviewed. The common reasons for 90 day ED visits were pain (15.8%) and swelling (15.6%).2 Patients with ankle fractures requiring surgical intervention present with edema and pain requiring time and traditional edema management prior to surgery. The impact of a neuromuscular stimulation device (NMES) on peripheral edema in the orthopaedic population will be examined. A literature review was conducted using Cochrane Review, PubMed, Google Scholar, and cross-references using search words edema, electric nerve stimulation, arthroplasty, ankle/knee surgery and bloodflow. Seven papers were reviewed, 5 reported the impact of NMES on bloodflow, edema and hospitalization. One study compared bloodflow in the peroneal, posterior tibial and gastrocnemial veins with and without NMES in healthy volunteers. Peak velocity, ejected volume/stimulus, and volume flows during muscle contraction demonstrated statistically a significant increase using NMES.3 Twenty patients requiring ankle fracture fixation reported 60% of participants were surgery ready after 2 NMES treatment days vs. 27% in the control group (P < 0 .01).4 Nine patients with ankle sprains and swelling demonstrated improvement with NMES.5 Forty participants following hip replacement demonstrated decreased leg volume, compared to the compression stockings group.6 In 118 post renal transplant patients a significant decrease in calf and thigh circumference was noted in the NMES group vs standard of care (P < .002)7 Edema impacts the healing trajectory of arthroplasty or ankle sprain patients. Edema, following ankle fracture can delay time to surgery. ED visits post TKR or THR surgery due to edema and pain are substantial. Although traditional treatment modalities remain in place, NMES has demonstrated a superior effect in reducing or preventing edema in the orthopaedic population. Further studies are needed to define the benefits in each indication.