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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

Short-stretch, inelastic compression bandage.
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Fig2: Short-stretch, inelastic compression bandage.

Mentions: The compression bandage is applied over the hydrocolloid surgical wound dressing. A soft inner layer (Soffban, BSN Medical Ltd, Brierfield, UK) is applied from the toes to the groin on the affected leg with a 50% overlap of bandage. Following this the outer compressive layer bandage (Actico bandage, Activa Healthcare Ltd, UK) is applied firmly over the top, again with a 50% overlap of bandage. The bandage is pulled to full stretch before it is wrapped around the leg to ensure adequate compression in the application (FigureĀ 2). A short-stretch, inelastic compressive bandage has been chosen because it is tolerable overnight due to its low resting pressure, yet produces high pressure with movement to greatly improve the efficacy of the calf muscle pump. The bandage is applied from the toes upwards. The application of bandage from thigh to groin requires removal of the tourniquet first and so the leg is kept elevated until the bandaging is complete. To ensure homogeneity in bandage application, the operating surgeons were shown a training video on correct application of the bandage and were given a tutorial on bandage application with real life bandage application and feedback. Correct bandage application was checked throughout the trial by the lead author and research nurse. The bandage is removed at 24 hours post-surgery leaving the hydrocolloid wound dressing in-situ. Otherwise the protocol follows that of the standard care group.Figure 2


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)

Short-stretch, inelastic compression bandage.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Short-stretch, inelastic compression bandage.
Mentions: The compression bandage is applied over the hydrocolloid surgical wound dressing. A soft inner layer (Soffban, BSN Medical Ltd, Brierfield, UK) is applied from the toes to the groin on the affected leg with a 50% overlap of bandage. Following this the outer compressive layer bandage (Actico bandage, Activa Healthcare Ltd, UK) is applied firmly over the top, again with a 50% overlap of bandage. The bandage is pulled to full stretch before it is wrapped around the leg to ensure adequate compression in the application (FigureĀ 2). A short-stretch, inelastic compressive bandage has been chosen because it is tolerable overnight due to its low resting pressure, yet produces high pressure with movement to greatly improve the efficacy of the calf muscle pump. The bandage is applied from the toes upwards. The application of bandage from thigh to groin requires removal of the tourniquet first and so the leg is kept elevated until the bandaging is complete. To ensure homogeneity in bandage application, the operating surgeons were shown a training video on correct application of the bandage and were given a tutorial on bandage application with real life bandage application and feedback. Correct bandage application was checked throughout the trial by the lead author and research nurse. The bandage is removed at 24 hours post-surgery leaving the hydrocolloid wound dressing in-situ. Otherwise the protocol follows that of the standard care group.Figure 2

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