ELAINE TARDIF RNJILL ALLEN RN MClSc WOCN/ET

Case Study Demonstrating the Effectiveness of a Two Layer Cohesive Compression Bandage Following Primary Total Knee Arthroplasty

CAWC 2014 – Poster #0090 © 2014, 3M. All rights reserved. Printed in Canada. 3M is a trademark of 3M. Used under license in Canada. 1409-01960-E

In Canada from 2010-2011 there were 50,733 primary total knee arthroplasty surgeries. One of the variable side effects is post-op edema. This swelling can slow down the healing process, decrease joint function and patient’s mobilization and cause considerable pain.

Some surgeons apply compression dressings, others prescribe compression stockings post-operatively, however no ‘gold standard of treatment’ to prevent edema from developing seems to exist.

With the aging population and increasing obesity rates, the demand for this surgery is expected to increase.

This case study demonstrates the reduction of post-op edema and blisters following primary total knee arthroplasty by application of a two layer cohesive compression bandage.

This 71 year old female with Type 2 diabetes, hypertension and arthritis had a tendinitis in the affected knee in 2013 which reduced her mobility due to pain.

By day 8 post primary total knee arthroplasty surgery, the patient had developed a very swollen left leg making movement and exercises difficult. There were numerous small blisters present on the limb causing discomfort as well. Photos and measurements were taken. A two layer cohesive compression bandage was applied at full stretch from the base of the toes to below the knee on day 8. Photos and measurements were taken after the staples were removed on day 11 and a new two layer cohesive compression bandage was reapplied.

Within 2 days, the blisters had resolved and the swelling had reduced (foot circumference decreased by 2 cm, ankle by 2.5 cm, calf by 4.5 cm and below the knee by 3.5 cm). The home care physiotherapist said she was impressed by the decrease in swelling and how comfortable this compression bandage was for the patient. From her experience with compression stockings, patients tend to refuse to wear them because of the pain they cause. According to the physiotherapist, the movement and amplitudes the patients reach post-op are impacted by the edema and pain.

In this case study, application of the two layer cohesive compression bandage on day 8 post primary total knee arthroplasty had a positive outcome decreasing both edema and pain. If the two layer compression bandage system was applied immediately post-op, would the resultant edema have been reduced improving

comfort and mobility? Would the length of rehab been shorter? Would the risk of surgical site infection decrease? These questions need further investigation to optimize patient outcomes.

References1. CIHI. Hip and Knee Replacements in Canada: Canadian Joint

Replacement Registry 2013 Annual Report.2. Namba, Inacio, Paxton, 2013. Risk Factors Associated with Deep

Surgical Site Infections After Primary Total Knee Arthroplasty. Journal of Bone and Joint Surgery. (95):775-82.

3. Obesity in Canada report, Public Health Agency of Canada and Canadian Institute for Health Information, June 2011.

CAWC 2014 – Poster #0090

RESULTS

PURPOSE

8 Days 10 Days 13 Days Post Op Post Op Post Op Foot 25,5 cm 24,5 cm 23,5 cm

Ankle (bone) 26,5 cm 26 cm 24 cm

Calf (9 in. from floor) 35,5 cm 32,5 cm 31 cm

Under knee (15 in. from floor) 44 cm 43 cm 41,5 cm

Thigh (1/2 way) 57,5 cm 57 cm 56,5 cm

Numerous SmallBlisters – Day 8

Blisters ResolvedDay 10

CONCLUSION INTRODUCTION METHODOLOGY

Two layer cohesive compression bandage applied at full stretch