Limits...
Short-stretch inelastic compression bandage in knee swelling following total knee arthroplasty study (STICKS): study protocol for a randomised controlled feasibility study.

Brock TM, Sprowson AP, Muller S, Reed MR - Trials (2015)

Bottom Line: Enhanced recovery programmes in total knee arthroplasty are well established.The bandages are applied by one of two consultant surgeons who have had training with their application.The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups.

View Article: PubMed Central - PubMed

Affiliation: NIHR academic clinical fellow and orthopaedic registrar, Wansbeck General Hospital, Woodhorn Lane, Northumberland, NE63 9JJ, UK. t.m.brock@doctors.org.uk.

ABSTRACT

Background: Enhanced recovery programmes in total knee arthroplasty are well established. Post-operative knee swelling is common and impairs early post-operative function. The use of a short-stretch, inelastic compression bandage is hypothesised to reduce knee swelling and improve pain and early function. A study was designed to test feasibility with a view to informing a larger, future trial and to provide preliminary data.

Methods/design: This is a randomised controlled feasibility study. Fifty consecutive patients selected for primary total knee arthroplasty will be enrolled in the trial. Patients with a BMI >35, latex allergy or neurological or peripheral vascular disease are excluded. Patients are randomised by distance randomisation to receive a compression bandage for 24 hours after surgery or a standard wool and crepe bandage. The bandages are applied by one of two consultant surgeons who have had training with their application. Knee swelling, range of motion and pain scores will be compared pre-operatively and at day 1, day 2 and at 6 weeks between groups. The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups. Recruitment rates, retention rates, resource allocation, completeness of data collection, and tolerance and complications with the compression bandage are recorded. Descriptive statistics are used to calculate a standard deviation for post-operative knee swelling in the groups and to perform a power calculation incorporating anticipated patient retention rates to inform a future trial. Preliminary data will be analysed using the independent samples t-test for equal distributions and the Mann-Whitney U for unequal distributions with the significance denoted at P <0.05.

Discussion: Enhanced recovery programmes have revolutionized the management of total knee arthroplasty. There is a paucity of clinical data regarding the efficacy of compression bandages. Large, randomised controlled trials are uncommon in orthopaedic surgery. The results of this study will provide feasibility and preliminary data prior to the construction of a larger, multicentre study.

Trial registration: The study was registered with Current Controlled Trials ( ISRCTN86903140 ) on 30 May 2013.

No MeSH data available.


Related in: MedlinePlus

Standard wool and crepe bandage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4359445&req=5

Fig1: Standard wool and crepe bandage.

Mentions: Patients undergo primary total knee arthroplasty under the care of one of two consultant orthopaedic surgeons (SM, MR). Surgery is with either general anaesthesia or spinal anaesthesia and sedation. Intravenous antibiotics (gentamicin 3 mg/kg and teicoplanin 400 mg iv) and tranexamic acid (30 mg/kg iv up to 2.5 g) are administered and a tourniquet is used. A Nexgen cruciate retaining total knee arthroplasty is routinely used for primary total knee arthroplasty in the trust (Zimmer, Swindon, United Kingdom) with Palacos R + G bone cement (Heraeus Medical, Newbury, United Kingdom). Intra-operative periarticular injections of 80 ml 0.125% bupivacaine are infiltrated, and a further 20 ml 0.125% bupivicaine bolus is given via intra-articular wound catheter after wound closure. The skin is closed using surgical skin clips, which are removed at 10 to 14 days post-operatively. A hydrocolloid dressing (Aquacel surgical, Convatec Ltd, Flintfield, UK) is used for the wound. Standard bandaging consists of a soft inner layer (Soffban, BSN Medical Ltd, Brierfield, UK) applied from 10 cm below to 10 cm above the patella with a 50% overlap of bandage, followed by a similar outer layer of crepe bandage (BSN Medical Ltd, Brierfield UK) prior to deflation of the tourniquet (FigureĀ 1).Figure 1


Short-stretch inelastic compression bandage in knee swelling following total knee arthroplasty study (STICKS): study protocol for a randomised controlled feasibility study.

Brock TM, Sprowson AP, Muller S, Reed MR - Trials (2015)

Standard wool and crepe bandage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359445&req=5

Fig1: Standard wool and crepe bandage.
Mentions: Patients undergo primary total knee arthroplasty under the care of one of two consultant orthopaedic surgeons (SM, MR). Surgery is with either general anaesthesia or spinal anaesthesia and sedation. Intravenous antibiotics (gentamicin 3 mg/kg and teicoplanin 400 mg iv) and tranexamic acid (30 mg/kg iv up to 2.5 g) are administered and a tourniquet is used. A Nexgen cruciate retaining total knee arthroplasty is routinely used for primary total knee arthroplasty in the trust (Zimmer, Swindon, United Kingdom) with Palacos R + G bone cement (Heraeus Medical, Newbury, United Kingdom). Intra-operative periarticular injections of 80 ml 0.125% bupivacaine are infiltrated, and a further 20 ml 0.125% bupivicaine bolus is given via intra-articular wound catheter after wound closure. The skin is closed using surgical skin clips, which are removed at 10 to 14 days post-operatively. A hydrocolloid dressing (Aquacel surgical, Convatec Ltd, Flintfield, UK) is used for the wound. Standard bandaging consists of a soft inner layer (Soffban, BSN Medical Ltd, Brierfield, UK) applied from 10 cm below to 10 cm above the patella with a 50% overlap of bandage, followed by a similar outer layer of crepe bandage (BSN Medical Ltd, Brierfield UK) prior to deflation of the tourniquet (FigureĀ 1).Figure 1

Bottom Line: Enhanced recovery programmes in total knee arthroplasty are well established.The bandages are applied by one of two consultant surgeons who have had training with their application.The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups.

View Article: PubMed Central - PubMed

Affiliation: NIHR academic clinical fellow and orthopaedic registrar, Wansbeck General Hospital, Woodhorn Lane, Northumberland, NE63 9JJ, UK. t.m.brock@doctors.org.uk.

ABSTRACT

Background: Enhanced recovery programmes in total knee arthroplasty are well established. Post-operative knee swelling is common and impairs early post-operative function. The use of a short-stretch, inelastic compression bandage is hypothesised to reduce knee swelling and improve pain and early function. A study was designed to test feasibility with a view to informing a larger, future trial and to provide preliminary data.

Methods/design: This is a randomised controlled feasibility study. Fifty consecutive patients selected for primary total knee arthroplasty will be enrolled in the trial. Patients with a BMI >35, latex allergy or neurological or peripheral vascular disease are excluded. Patients are randomised by distance randomisation to receive a compression bandage for 24 hours after surgery or a standard wool and crepe bandage. The bandages are applied by one of two consultant surgeons who have had training with their application. Knee swelling, range of motion and pain scores will be compared pre-operatively and at day 1, day 2 and at 6 weeks between groups. The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups. Recruitment rates, retention rates, resource allocation, completeness of data collection, and tolerance and complications with the compression bandage are recorded. Descriptive statistics are used to calculate a standard deviation for post-operative knee swelling in the groups and to perform a power calculation incorporating anticipated patient retention rates to inform a future trial. Preliminary data will be analysed using the independent samples t-test for equal distributions and the Mann-Whitney U for unequal distributions with the significance denoted at P <0.05.

Discussion: Enhanced recovery programmes have revolutionized the management of total knee arthroplasty. There is a paucity of clinical data regarding the efficacy of compression bandages. Large, randomised controlled trials are uncommon in orthopaedic surgery. The results of this study will provide feasibility and preliminary data prior to the construction of a larger, multicentre study.

Trial registration: The study was registered with Current Controlled Trials ( ISRCTN86903140 ) on 30 May 2013.

No MeSH data available.


Related in: MedlinePlus