Bimmel, Richard

Damstra, Robert J.

Hendrickx, Ad A.

Krijnen, Wim P.

van der Schans, Cees P.

Dissertations of the University of Groningen

   University of GroningenCompression with the Juxta Reduction Kit ® (medi) in patients undergoing a total kneearthroplastyHendrickx, Ad A.; Krijnen, Wim P.; Damstra, Robert J.; Bimmel, Richard; van der Schans,Cees P.Published in:Veins and LymphaticsDOI:10.4081/vl.2017.6622IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2017Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Hendrickx, A. A., Krijnen, W. P., Damstra, R. J., Bimmel, R., & van der Schans, C. P. (2017). Compressionwith the Juxta Reduction Kit ® (medi) in patients undergoing a total knee arthroplasty. Veins andLymphatics, 6(6622). https://doi.org/10.4081/vl.2017.6622CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.                             Veins and Lymphatics 2017; volume 6:6622[page 2]                                                            [Veins and Lymphatics 2017; 6:6622]Compression with the JuxtaReduction Kit ® (medi) inpatients undergoing a totalknee arthroplastyAd A. Hendrickx,1,2 Wim P. Krijnen,1Robert J. Damstra,2 Richard Bimmel,3Cees P. van der Schans2,41Expert Centre of Lympho-VascularMedicine, Nij Smellinghe Hospital,Drachten; 2Research and InnovationGroup in Health Care and Nursing,Hanze University of Applied Sciences,Groningen; 3Department ofOrthopaedics and Traumatology, NijSmellinghe Hospital, Drachten;4Department of Rehabilitation Medicine,University of Groningen, UniversityMedical Center Groningen, TheNetherlandsIntroductionTotal knee replacement (TKA) is a suc-cessful operation in the treatment ofosteoarthritis. Enhanced recovery pro-grams, with emphasis on early mobilizationand optimal analgesics have reduced hospi-tal stay and peri-operative morbidity.1,2Patients undergoing a knee arthroplastycan experience pain, swelling, a decrease inknee-extension strength, loss of range ofmotion (ROM), causing a decline in func-tional performance.3-6 Problems with theactivation of the quadriceps, in the earlypostoperative phase can be related to eitherthe surgical procedure or arthrogenic reflexinhibition of the muscle related to pain andswelling.7Post-operative swelling is mainlycaused by intra-articular bleeding andinflammation of peri articular tissues.8Impaired functional performance candelay rehabilitation and affect length of stayand patient-reported outcomes.8Thereby, excessive swelling is associat-ed with increased rates of wound dehis-cence and infection in surgical wounds.9Compression therapy is a frequentlyused modality in the postoperative treat-ment to reduce swelling. The literature isnot consistent about the effects of compres-sion therapy. This is due to the use of vari-ous materials, the time frame of applicationand the different outcome measurementsused.8,10,11 Our experiences with compres-sion in the treatment of venous ulcers andlymphedema create possibilities to intro-duce compression technologies in otherfields of medicine, such as orthopaedic sur-gery.Regarding the type of bandage, inelasticcompression bandages show a low, tolera-ble resting pressure and a more effectiveactivation of the deep venous system andcalf muscle pump with ambulation (work-ing pressure) compared to elastic materi-als.12,13The Juxta Reduction Kit® (JRK) is anon-elastic compression device, suitable forself-management, which can be tailored tothe circumference of the leg. The deviceallows full ROM, so ambulation and exer-cise will not be impaired. It is hypothesized that immediate post-operative compression and prolonging theperiod of use until 6 weeks postoperativelywill prevent excessive swelling and initiatean earlier reduction. Reduced swellingimproves range of motion, knee extensionstrength, reduces pain, supporting the reha-bilitation process.The research questions concern feasibil-ity and effectiveness of the treatment onvolume, pain, wound aspects and functionalrecovery. In this article we will focus onstudy design and feasibility aspects. Materials and MethodsIn Nij Smellinghe hospital the fast-trackprinciples have been implemented in jointreplacement surgery. Ambulation and exercise of the patientstart 4 hours postoperative and patients aredischarged when they are functional inde-pendent.Table 1 shows the compression andexercise protocols for the control and treat-ment group. Patients are instructed about the use ofthe JRK prior to the operation and duringclinical stay. They are instructed to apply afirm, but tolerable dose of compression. After having signed the inform consentpatients are randomly assigned to either thecontrol or the treatment group. Inclusion criteria: i) 18 years of age orolder; ii) patients undergoing aprimary elective total knee arthroplasty; iii)the patient is able to understand the studyand is willing to give written InformedConsent.Exclusion criteria: i) allergy against oneof the used materials; ii) severe systemicdiseases causing peripheral edema; iii)acute superficial or deep vein thrombosis;iv) arterial occlusive disease (stadium II, IIIor IV) ABPI<0.8; v) local infection in thetherapy area; vi) auto-immunological disor-ders or vasculitis; vii) use of systemic corti-costeroids; viii) inability to don, doff andadjust the device.The local Medical Ethical Committeeapproved the study. The study was regis-tered under ClinicalTrials.gov,NCT02375945. Measurements and data collection Feasibility data are collected about thenumber of patients recruited and droppedout, time required for the whole process(measurements, preparation of the JRK,instruction of the patient and administra-tion), pain in action (PA) and in rest (PR),the ability to exercise and sort and numberof complications. Data collection was pre-operative, day1 and day 2 during hospital stay and at day14, 42 and 84 after discharge. Statistical analysesAll data are analyzed with the program-ming language R version 3.3.0 for statisticalcomputing. A P-value smaller than or equalto 0.05 is considered to be statistically sig-nificant.ResultsIn total 68 patients were included (32patients in the control group and 36 patientsin the treatment group). 19 patients in thecontrol group (13 drop outs) and 20 patientsthe treatment group (16 drop outs) complet-ed the study. Measurements, preparation of the JRK,instruction and administration demanded 6hours per patient. Pain scores in rest and action are shownin Figure 1. Figures 2 and 3 show the inter-action data plots. The ability to exercise was successful inthe first phase of recovery. When the ROMcomes closer to the 90 degrees of flexionthe material strips up at the back of the kneeand restricts the possibility to flex the knee. No complications did occur. Correspondence: Ad A. Hendrickx, NijSmellinghe Hospital, Department of PhysicalTherapy, Compagnonsplein 1, 9202 NNDrachten, The Netherlands.E-mail: a.hendrickx@nijsmellinghe.nl This work is licensed under a CreativeCommons Attribution 4.0 License (by-nc 4.0).©Copyright A.A. Hendrickx et al., 2017Licensee PAGEPress, ItalyVeins and Lymphatics 2017; 6:6622doi:10.4081/vl.2017.6622Non commercial use only                                                                                          Conference presentation                                       [Veins and Lymphatics 2017; 6:6622]                                                          [page 3]ConclusionsThe VAS scores for pain in rest and inaction showed no significant differencesbetween the two groups. Regarding feasibil-ity this is considered positive, because morepain was expected by adding compressionin the first phase of recovery. A limitation ofthis study is that no data were collectedabout the use of pain-medication. The anal-gesic influence of compression on the paincannot be stated. This pilot study demonstrates a feasibleconcept. Regarding outcome on volume thepreliminary results show a positive effect infavor of the treatment group, supporting theneed for further research. Table 1. Compression and exercise protocol.Control group                                                                                             Treatment group •  Immediately postoperative until 24 hours postoperative compression                •  Immediately postoperative until 6 weeks postoperative, 24/7      with elastic bandages for the knee region with Elastomuhl Haft® (Jobst)             compression with the JRK ®+ Struva®, class 2 anti-thrombosis stocking•  From 24h until 6 weeks postoperative an anti-thrombosis stocking,                        (medi)     Comprinet stocking ® (BSN Medical)•  Ambulation and exercise program according to the fast-track principles            •  Ambulation and exercise program according to the fast-track principlesFigure 1. Pain scores in rest and action.Figure 2. Interaction plot pain in action (PA).Non commercial use only                             Conference presentation[page 4]                                                            [Veins and Lymphatics 2017; 6:6622]References1. Khan SK, Malviya A, Muller SD, et al.Reduced short-term complications andmortality following enhanced recoveryprimary hip and knee arthroplasty:results from 6,000 consecutive proce-dures. Acta Orthop 2014;85:26-31.2. Berend KR, Lombardi Jr AV, MalloryTH. Rapid recovery protocol for peri-operative care of total hip and total kneearthroplasty patients. Surg Technol Int2004;13:239-47.3. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and thetime course of functional recovery aftertotal knee arthroplasty. J Orthop SportsPhys Ther 2005;35:424-36.4. Mizner RL, Petterson SC, Stevens JE,et al. Early quadriceps strength lossafter total knee arthro- plasty. The con-tributions of muscle atrophy and failureof volun- tary muscle activation. J BoneJoint Surg Am 2005;87:1047-53.5. Mizner RL, Snyder-Mackler L. Alteredloading during walking and sit-to-standis affected by quadriceps weakness aftertotal knee arthroplasty. J Orthop Res2005;23:1083-90.6. Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength andvolitional activation before and aftertotal knee arthroplasty for osteoarthritis.J Orthop Res 2003;21:775-9.7. Holm B, Kristensen MT, Bencke J, etal. Loss of knee-extension strength isrelated to knee swelling after total kneearthroplasty. Arch Phys Med Rehabil2010;91:1770-6.8. Brock TM, Sprowson AP, Muller S,Reed MR. Short-stretch inelastic com-pression bandage in knee swelling fol-lowing total knee arthroplasty study(STICKS): Study protocol for a ran-domised controlled feasibility study.Trials 2015;16:87.9. Yu GV, Schubert EK, Khoury WE. TheJones compression bandage. Reviewand clinical applications. J Am PodiatrMed Assoc 2002;92:221-31.10. Munk S, Jensen NJ, Andersen I, et al.Effect of compression therapy on kneeswelling and pain after total kneearthroplasty. Knee Surg SportsTraumatol Arthrosc 2013;21:388-92.11. Andersen LO, Husted H, Otte KS, et al.A compression bandage improves localinfiltration analgesia in total kneearthroplasty. Acta Orthop 2008;79:806.12. Partsch H, Menzinger G, Mostbeck A.Inelastic leg compression is more effec-tive to reduce deep venous refluxes thanelastic bandages. Dermatol Surg1999;25:695-700.13. Spence RK, Cahall E. Inelastic versuselastic leg compression in chronicvenous insufficiency: a comparison oflimb size and venous hemodynamics. JVasc Surg 1996;24:783-7.Figure 3. Interaction plot pain in rest (PR).Non commercial use only

English

Compression with the Juxta Reduction Kit ® (medi) in patients undergoing a total knee arthroplasty

Damstra, Robert

ARTS repository - University of Groningen

Proceedings - University of Groningen

Ad A. Hendrickx

Wim P. Krijnen

Robert J. Damstra

Richard Bimmel

Cees P. Van der Schans

Crossref

Veins and Lymphatics

University of Groningen

Hendrickx, Ad

van der Schans, Cees

Hanze UAS repository

Compression with the Juxta reduction Kit (medi) in patients undergoing a total knee arthroplasty

NARCIS 

Cees P. van der Schans

Directory of Open Access Journals

Compression with the Juxta Reduction Kit ® (medi) in patients undergoing a total knee arthroplasty

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Dissertations of the University of Groningen

ARTS repository - University of Groningen

Proceedings - University of Groningen

ARTS repository - University of Groningen

Crossref

University of Groningen

Proceedings - University of Groningen

Hanze UAS repository

NARCIS

Directory of Open Access Journals