Authors (including presenting author) :
Lam WY, Wong PK, Tang YS, Chan SL, Lee PY, Hilary Chung
Affiliation :
Department of Orthopaedics & Traumatology
Introduction :
Patients after total knee replacement surgery commonly suffer from wound pain and knee swelling, which may diminish knee range of motion and hinder patient early functional recovery. Various modalities and regime of cold therapy were used to minimize patient postoperative knee pain and swelling but no consensus on which would be the best practice.
Objectives :
To develop an evidence-based protocol (EBP) on the use of cold compression therapy in reducing postoperative pain and knee swelling for patients after total knee replacement surgery.
Methodology :
Johns Hopkins Nursing Evidence-based Model and Guideline was adopted as our project conceptual model. The EBP question is defined as “What is the most effective cold compression therapy modality and regime in reducing pain and swelling for the patients after total knee replacement surgery?” A literature search was conducted using CINAHL Complete, OVID, MEDLINE, and Cochrane Library. Keywords for the search included total knee replacement/arthroplasty, ice therapy/cold therapy/ cryotherapy. Five RCT studies, 6 systematic reviews and local data were reviewed and appraised. The level of evidence ranged from IIB to IA. After evaluating the evidence, recommendations were concluded as continuous 48 hours application of active cold pneumatic compression device on operated knee, with cycles of 30-minutes on/off at 10℃ and low pressure (15mmHg). After confirmation support from stakeholders and decision-makers, the inclusion criteria were restrained to “Fast Track” total knee patient and the regime of cold compression therapy was amended to 12 hours continuously (8pm to 8am) on postoperative day 0, day 1 and day 2 in order to fit our department local context.
Result & Outcome :
The EBP protocol was developed and translated to practice since September 2018. One male and seven female patients with mean age of 65.9 were recruited to this project. The application of continuous cold compression therapy during the acute postoperative phase improved pain and patient satisfaction. Feedback from patients was positive with the mean satisfaction score of 4.5 over 5. This EPB protocol on the use of continuous active cold pneumatic compression therapy enhanced our department service in the way of promoting patients recovery effectively after total knee replacement surgery.
Co-location with:
