What is the cause of diffuse leg swelling after Total Knee Arthroplasty (TKA)?

From the Guidelines

Diffuse leg swelling after total knee arthroplasty (TKA) should be managed with a combination of elevation, cold therapy, compression, and physical therapy to reduce swelling and improve circulation, as suggested by the most recent guidelines 1. To manage diffuse leg swelling after TKA, the following measures can be taken:

• Elevate the affected leg above heart level for 20-30 minutes several times daily, particularly after activity.
• Apply cold therapy using ice packs wrapped in a thin towel for 15-20 minutes every 2-3 hours during the first few weeks.
• Use compression therapy with elastic bandages or compression stockings (20-30 mmHg) when upright.
• Perform gentle ankle pumping exercises (flexing and extending the foot) hourly while awake to improve circulation.
• Engage in physical therapy focusing on quadriceps strengthening and range of motion exercises to reduce swelling by improving muscle function and circulation.
• Avoid prolonged standing or sitting and maintain a low-sodium diet to minimize fluid retention. It is essential to monitor the swelling and seek medical attention immediately if it worsens suddenly, is accompanied by severe pain, redness, warmth, or fever, as these could indicate complications such as infection or deep vein thrombosis 1. The management of diffuse leg swelling after TKA is crucial to prevent complications and improve patient outcomes, and the most recent guidelines suggest a multidisciplinary approach to manage this condition 1. Some key points to consider in the management of diffuse leg swelling after TKA include:
• The importance of early mobilization and physical therapy to improve circulation and reduce swelling.
• The use of compression therapy and elevation to reduce swelling and improve venous return.
• The need for regular follow-up and monitoring to detect any potential complications early.
• The importance of patient education on the management of swelling and the recognition of potential complications 1.

From the Research

Diffuse Leg Swelling Post TKA Length

• The length of diffuse leg swelling post total knee arthroplasty (TKA) can vary, but studies have shown that swelling typically increases immediately after surgery and then gradually decreases over time 2.
• One study found that knee swelling increased by approximately 35% from preoperative levels on post-operative day 1, and then reduced but remained about 11% above preoperative levels on post-operative day 90 2.
• Another study examined the use of compression bandages after TKA and found no significant difference in leg swelling between patients with and without compression bandages at various time points, including post-operative days 1,2, and 28 3.
• The use of anticoagulant medications, such as low-molecular-weight heparin and fondaparinux sodium, has been shown to be effective in preventing deep vein thrombosis (DVT) after TKA, but their impact on leg swelling is not well established 4, 5, 6.
• Factors such as quadriceps strength and gait speed have been associated with knee swelling after TKA, suggesting that interventions to improve these outcomes may also help reduce swelling 2.

Associations with Quadriceps Strength and Gait Speed

• Knee swelling after TKA has been associated with quadriceps weakness and slower gait speed, suggesting that reducing swelling may be important for improving these outcomes 2.
• Interventions aimed at reducing knee swelling, such as compression bandages or anticoagulant medications, may also have an impact on quadriceps strength and gait speed, although more research is needed to fully understand these relationships 3, 4, 5, 6.

Anticoagulant Medications

• Anticoagulant medications, such as low-molecular-weight heparin and fondaparinux sodium, are commonly used to prevent DVT after TKA 4, 5, 6.
• These medications have been shown to be effective in preventing DVT, but their impact on leg swelling is not well established 4, 5, 6.
• The choice of anticoagulant medication may depend on various factors, including patient risk factors and medical history, as well as the potential for bleeding complications 4, 5, 6.