Comparison Between a Non-elastic Falcro Device and Current Method After Total Knee Arthroplasty
Comparison Between a Non-elastic Falcro Device and Current Method After Total Knee Arthroplasty
Swelling is a common problem after knee arthroplasty often leading to delayed wound healing,
 lasting functional impairment and hematoma.

 Due to this complications, sometimes the risk for deep venous thrombosis is raised. This
 study investigates a new self adjustable device to reduce swelling more effective
 postoperatively. The investigators compare the new device to the current general practice by
 using a standard class 1 elastic stocking
Purpose Pain, swelling and inflammation are expected during early recovery from total knee
 arthroplasty (TKA). Compression therapy is a frequently used modality in the direct post
 operative treatment, but there is a great variety in the use of materials, the way and time
 frame of application. The most common goals of the compression therapy are prevention and
 reduction of the swelling. At the same time the literature is not consistent about the use
 and effects of compression therapy other than for prevention of trombo-embolic processes The
 state of the art care concepts for patients undergoing a total knee arthroplasty embraces the
 concept of "fast track" (Kehlet et al) with important parts as early mobilisation and optimal
 analgesics. In the investigators hospital this concept has already been implemented.

 During the stay in the hospital the challenge is to give adequate compression therapy to
 prevent and reduce swelling and enhance woundhealing. At the same time it is essential to
 optimise ambulation of the patient and the possibilities to exercise.

 The current protocol in the investigators hospital consists of 24 hours compression therapy
 with "Elastomull Haft ®", an elastic bandage for the knee region, combined with a Comprinet
 stocking (BSM Medical®) for anti thrombotic purposis. The anti thrombosis stocking is worn
 for a period of 6 weeks.

 The compression is combined with the use of the Continious Passive Motion device for 4 hours
 post operatively (2 hours immobilisation in a position of 90 degrees flexion, followed by 2
 hours hours of passive motion in a range of 60-90 degrees flexion). Four hours post
 operatively the patient is ambulatend and the physical therapy starts.

 The investigators wonder if this is the optimal way of post-operative care. Swelling of the
 knee and the whole leg can remain a problem in the first 6 weeks of recovery which inhibits
 rehabilitation. Sometimes delayed woundhealing will occur and patients may complain of more
 durable pain which make analgesics necessary.

 Prolonging adequate compression could improve the post-operative course and support the total
 rehabilitation process.

 The "Juxta Reduction Kit (by Medi) ®" , applied for the knee could be an adequate solution to
 replace the current protocol of compression therapy.

 The "Juxta Reduction Kit ®" is a non-elastic compression device which can be tailored (by
 cutting it to the correct size) to the circumference of the leg prior to the operation.
 Direct post operatively the compression device can be adjusted by the staff and in the
 following days patients are enabled to adjust the device by themselves by using the Velcro
 ties to loosen or fasten it.

 The device is suitable in early mobilisation and gives the patient tools for selfmanagement
 of the compression by using the Velcro flaps. The material doesn't restrict the range of
 motion and so the possibility to ambulate and to exercise as advised in the fast track
 concept is optimised.

 In this study the patients will use the compression device for a period of six weeks in
 combination with an anti thrombosis stocking (Struva class 2) Outcome parameters will be
 measured in a scheduled way, described in scheme 1.
Inclusion Criteria:

 -  18 years of age or older

 -  Patients undergoing a primary elective total knee arthroplasty

 -  The patient is able to understand the study and is willing to give written informed
 consent to the study.

 Exclusion Criteria:

 -  Allergy against one of the used materials

 -  Severe systemic diseases causing peripheral oedema

 -  Acute superficial or deep vein thrombosis

 -  Arterial occlusive disease (stadium II, III or IV) ABPI<0,8

 -  Local infection in the therapy area

 -  auto-immunological disorders or vasculitis

 -  use of systemic corticosteroids

 -  Inability to don, doff, and adjust the device