Swelling Management in Total Knee Arthroplasty: A Systematic Review.

IF 2.4 Q2 SURGERY

JBJS Reviews Pub Date : 2025-09-08 eCollection Date: 2025-09-01 DOI:10.2106/JBJS.RVW.25.00109

Luke McGarry, Jack Kearney, Jessica Rotaru, Rajitha Gunaratne

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引用次数: 0

Abstract

Background: Postoperative swelling is a common complication after total knee arthroplasty (TKA), associated with pain, limited mobility, and delayed recovery. This study aimed to systematically review the literature on interventions that reduce postoperative swelling, categorized into preoperative, intraoperative, and postoperative phases.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of PubMed, Medline, Embase, and Cochrane databases was performed for clinical studies evaluating interventions to reduce swelling after primary TKA. Data were grouped by intervention timing. Methodological quality was appraised using the Modified Jadad Score, Methodological Index for Non-Randomized Studies, and AMSTAR 2 tools.

Results: A total of 140 clinical studies were included, encompassing 7 meta-analyses, 125 randomized controlled trials, and 8 cohort studies. Tranexamic acid (TXA) was the most consistently effective intervention, particularly in repeated or combined regimens. Avoiding or limiting tourniquet (TQ) use, maintaining postoperative knee flexion (30°-90° for 6-72 hours), and applying cryotherapy during the first 2 weeks were consistently associated with reduced swelling. Other promising strategies included prehabilitation, aspirin cessation, cold intra-articular irrigation, mechanical compression, and adjunctive therapies like diosmin, acupuncture, and kinesiotaping. Interventions such as manual lymphatic drainage, continuous passive movement, and static compression bandaging showed inconsistent or no significant effects.

Conclusion: Several perioperative strategies reduce postoperative swelling after TKA, with the strongest evidence supporting TXA, TQ minimization, knee flexion, and cryotherapy. These findings should inform the design of multimodal enhanced recovery protocols optimized for swelling management. Future research should prioritize standardized outcome reporting and assess synergistic effects of combined interventions.

Level of evidence: Level I, systematic review. See Instructions for Authors for a complete description of levels of evidence.

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全膝关节置换术中的肿胀处理：系统回顾。

背景：术后肿胀是全膝关节置换术（TKA）后常见的并发症，与疼痛、活动受限和延迟恢复有关。本研究旨在系统回顾有关减少术后肿胀的干预措施的文献，分为术前、术中和术后三个阶段。方法：对PubMed、Medline、Embase和Cochrane数据库进行符合系统评价和荟萃分析的首选报告项目，对评估干预措施减少原发性TKA后肿胀的临床研究进行搜索。数据按干预时间分组。采用改良Jadad评分、非随机研究方法学指数和AMSTAR 2工具对方法学质量进行评价。结果：共纳入140项临床研究，包括7项荟萃分析、125项随机对照试验和8项队列研究。氨甲环酸（TXA）是最持续有效的干预，特别是在重复或联合治疗方案中。避免或限制止血带（TQ）的使用，术后保持膝关节屈曲（30°-90°）6-72小时，并在前2周内进行冷冻治疗，均可减少肿胀。其他有希望的策略包括康复、停用阿司匹林、冷关节内冲洗、机械压迫和辅助治疗，如地奥司明、针灸和运动胶带。手工淋巴引流、持续被动运动和静态压缩包扎等干预措施效果不一致或无显著效果。结论：几种围手术期策略可以减少TKA术后肿胀，其中最有力的证据支持TXA、TQ最小化、膝关节屈曲和冷冻治疗。这些发现应该为设计针对肿胀管理优化的多模式增强恢复方案提供信息。未来的研究应优先考虑标准化的结果报告，并评估联合干预措施的协同效应。证据等级：一级，系统评价。有关证据水平的完整描述，请参见作者说明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.