Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty

Arch Phys Med Rehabil. 2013 Nov;94(11):2103-11. doi: 10.1016/j.apmr.2013.06.009. Epub 2013 Jun 26.


Objective: To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion.

Design: Prospective randomized controlled trial.

Setting: Private hospital and functional rehabilitation clinic.

Participants: Consecutive sample of patients (N=43; 53 knees) scheduled for TKA.

Intervention: MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy.

Main outcome measures: Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score.

Results: A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes.

Conclusions: MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care.

Keywords: ADL; Arthroplasty, replacement, knee; BMI; KOOS; Knee Injury and Osteoarthritis Outcome Score; MLD; Massage; NRS; OA; ROM; Rehabilitation; TKA; activities of daily living; body mass index; manual lymphatic drainage; numeric rating scale; osteoarthritis; range of motion; total knee arthroplasty.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee*
  • Drainage / methods*
  • Edema
  • Female
  • Humans
  • Knee Joint / physiopathology
  • Lymphatic Vessels / physiopathology*
  • Male
  • Massage / methods
  • Middle Aged
  • Postoperative Care
  • Prospective Studies
  • Range of Motion, Articular
  • Treatment Outcome