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    Can Lymphatic Transport Impaired by Total Knee Arthroplasty be Managed with Manual Lymphatic Drainage?
    (Mary Ann Liebert, Inc, 2024) Cihan, Emine; Yildirim, Necmiye Un; Bakar, Yesim; Bilge, Onur
    Objective: It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Method: Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. Results: A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: chi(2) = 47.175; p = 0.000; control; chi(2) = 30.995; p < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; p = 0.015; p = 0.001; p < 0.000). Leg volume significantly decreased over time in both groups after surgery (p < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; p = 0.192; p = 0.343; p = 0.453; p = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; p = 0.002; p = 0.005; p = 0.006, respectively), it increased with exercise in the control group, first day (p = 0.004) and second day (p = 0.019). Conclusions: MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.
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    Outcomes with additional manual lymphatic drainage to rehabilitation protocol in primary total knee arthroplasty patients: preliminary clinical results
    (2021) Bilge, Onur; Cihan, Emine; Doral, Mahmut Nedim; Bakar, Yeşim; Yıldırım, Necmiye Ün
    Objective: This study was carried out to evaluate the clinical outcomes such as pain, kinesiophobia and quality of life of additional manual lymph drainage (MLD) technique in theafter total knee arthroplasty (TKA) surgery.Methods: Twenty-one TKA patients were randomly allocated to a control group (n:10) and MLD group (n:11). Both groups received routine postoperative rehabilitation. MLD group also received MLD in the first three days after surgery. Clinical assessment was undertaken on postoperative 3rd day and at 6th week. This included knee pain using Visual Analog Scale (VAS), kinesiophobia using Tampa Kinesiophobia Scale (TKS) and quality of life using Nottingham Health Profile (NHP).Results: VAS and TKS values of the MLD group on the 3rd day and at the 6th week were found to be significantly lower than the control group (p<0.05). The 6th week NHP values of the MLD group were found to be significantly lower than the control group (p<0.05). For all three values, within-group, and between-group according to processes the effect size of the MLD group is greater than the control group.Conclusion: The results of the present study demonstrated that addition of MLD application to the standard rehabilitation protocol of TKA positively affected the healing process and it also improved the quality of life by reducing postoperative kinesiophobia and pain level. Adding this special technique to the rehabilitation program in TKA surgeries will provide patient satisfaction and contribute positively to the improvement in clinical outcomes.