This article is Part 2 of our previous blog on “The use of Compression Therapy in Orthopaedic Post Operative conditions”. You can read Part 1 from our previous blog now or continue to Part 2.
Ideas for compression therapy after surgery
Compression therapy (CT) can come in several forms. Including bandaging, hosiery and wraps. (Pneumatic devices have not been included as they are not accessible for most patients). To decide which is appropriate requires an assessment by a knowledgeable medical professional.
Firstly, the medical professional must decide if Compression Therapy is safe to apply and will check for any contraindications. If CT is safe to use the choice of compression garment will depend on factors such as the state of swelling, purpose of the garment, comfort levels and ease of application. Choosing the correct compression garment increases patient compliance wearing the garment.
For instance, if swelling fluctuates and a person is able to walk an inelastic or short stretch garment (hosiery) may be appropriate. If hosiery is too difficult to put on, and independence is a priority, then possibly bandaging is the best choice. However, if learning to bandage proves difficult, then wraps maybe more suitable.
In some acute conditions, where swelling fluctuates and the limb is an abnormal shape, bandaging may be more appropriate to use at first. Once swelling becomes stable and the limb is a better shape, wraps or hosiery could be used. The decision of when and which compression garment to use can be confusing and getting advice from a medical professional will help.
When researching different types of compression garments each product was found to have limitations. Bandaging can provide compression at required levels only up to 5 hours. It would need to be reapplied at this time and requires specialist training. Hosiery often requires assistance to apply and would need replacing at 4 to 6 months. Wraps can be expensive to buy.
Once any type of CT garment is applied regular monitoring is important to prevent complications and ensure optimal results. It is possible more than one type of compression garment is used through different phases of healing.
An important consideration to make, when managing post operative swelling, is when should CT start. It makes sense to use compression garments at the earliest possible time if we want to prevent a limb from swelling. However, raw suture sites and a painful limb may make compression uncomfortable and contraindicated at such an early stage. Often TED stockings are used over dressings whist in hospital and in the fist 10-14 days post operation.
Once sutures and dressings have been removed 10-14 days post operatively, and the limb can tolerate compression, this may be the best time to enhance CT. By enhancing CT it may be possible to speed up the reduction in swelling and thereby reduce pain and increase range of motion. Early motion could possibly reduce the restriction in joints we often see after an operation and restore function and muscle activation sooner. Weight bearing may also be more comfortable and walking become easier.
Today, there are companies who can bespoke make compression garments if off the shelf garments do not fit. One such company is called Isobar. Isobar is involved in research to further improve their products. They are known to make products with reliable long lasting compression.
Another company, VR Compression, has noticed the need for more variety in colour and design of compression socks and tights whilst maintaining hospital standard compression. They produce medically graded compression for the more dress conscious patient.
Finally, we must not forget Compression works best when accompanied with muscle and joint pumping to promote better venous and lymphatic drainage. Elevation and Lymphatic drainage massage are also valuable treatment adjuncts for reducing swelling.
Conclusion
There is limited research on the use of Compression Therapy in Post operative orthopaedic conditions. More research is needed.
The ideas in this blog are based on literature taken from Compression Therapy in chronic conditions such as Lymphedema and Venous Insufficiency
Seek advice from a knowledgeable medical professional for appropriate prescription of Compression Therapy
The use of Compression Therapy can be improved in current orthopaedic post operative management
Reference list
Anderson I. How can we maximise the use of compression hosiery?. British Journal of Nursing 2012; Feb 9; 21(3): 144-146
Balcombe L, Miller C, McGuiness W. Approaches to the application and removal of compression therapy: a literature review. British Journal of Community Nursing 2018; Supplement10: 22 S6-S14
Bradley M, Nelis L, Reagen M, Collins S, Paterson R, Munro P, Cannon L, Rankin G. Using an adjustable compression device to manage venous leg ulcers. Journal of Community Nursing. Apr/May2017; 31(2): 40-44
Charalambides C, Beer M, Melhuish J, Williams RJ, Cobb AG. Bandaging technique after knee replacement. Acta Orthopaedica, Feb2005; 76(1): 89-94
Cheung A, Lykostratis H, Holloway I. Compression bandaging improves mobility following total knee replacement in an enhanced recovery setting. Journal of Perioperative Practice, Apr2014; 24(4): 84-86
Elwell R. An overview of the use of compression in Lower-limb Chronic oedema
British Journal of Community Nursing. January 2016; 21 (1): 36-42
Elwell R, Heal D, Lister L. Impact of JOBST® Elvarex® knee and elbow functional zones on quality of life. British Journal of Community Nursing 2018; Supplement10: 22 S58-S67
Fort C. Get pumped to prevent DVT: learn how pneumatic compression boots help prevent serious vascular complications in immobile patients…deep vein thrombosis. Nursing. Sep 2002; 32(9): 50-52
Hopkins A. Compression therapy for lymphoedema. Practice Nursing. Oct 2008; 19(10): 496-503
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websites
Cividien, TED stockings; https://tinyurl.com/y9ekhauv
Easywrap; https://www.easywrap.info/index.html
Gregory. Is there a difference between anti-embolism stockings and other compression stockings. 2012; https://tinyurl.com/y7dtu893
Helpful aid to put on compression socks; https://tinyurl.com/y9d2uet2
How to put on support stockings; https://www.youtube.com/watch?v=By9gTbgexCQ
Lymphatic system: crash course A&P #44; https://youtu.be/I7orwMgTQ5I
Principles of compression therapy; https://tinyurl.com/y75mmruz
Zuther J. The science behind compression therapy in lymphedema management. Lymphedema inform yourself and take control 2014; https://tinyurl.com/m7t5yb3
Compression garments suppliers
Bsnmedical; https://tinyurl.com/y8l899cw
Daylong; https://www.daylong.co.uk/shop-by-brand/activa.html
Easywrap; https://www.easywrap.info/index.html
Isobar; https://www.isobar-compression.com
VR compression; https://www.vrcompression.com
