477143681The use of manual lymphatic drainage in the days following total knee arthroplasty surgery resulted in increased active knee flexion on the fourth day after surgery, and this increase remained six weeks after surgery, according to a recent study.

The study, “Randomized Trial Investigating the Efficacy of Manual Lymphatic Drainage to Improve Early Outcome After Total Knee Arthroplasty,” involved 41 subjects between the ages of 45 and 90 with a primary diagnosis of knee osteoarthritis. All subjects underwent total knee arthroplasty surgery conducted by the same orthopedic surgeon.

For the study, patients were randomly assigned to one of two groups. Both groups received the same standard postoperative care and physical therapy, except one group was also assigned to receive manual lymph drainage.

For those patients in the manual lymph drainage group, the intervention began on the second day post-surgery, between the hours of noon and 2 p.m. It consisted of a 30-minute standardized manual lymph drainage session on the limb that had been operated on.

“Limb elevation while in a supine position, deep slow abdominal breathing to assist thoracic duct pumping, and application of gentle abdominal pressure (on exhalation) were followed by superficial inguinal lymph node stimulation,” state the study’s authors. “Light, stationary circular movements were used to stimulate the superficial lymph nodes.”

The researchers report that the focus was “initially on the proximal tissue, gradually moving distally to the area around the knee, popliteal region (and lymph nodes), and back proximally.” This sequence was repeated three to four times during each half-hour manual lymph drainage session. The intervention took place on days two, three and four following the surgery.

Main outcome measures for this study were active knee flexion and extension, girth of the lower limbs and knee pain as assessed on a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score. These outcome measures were assessed in all subjects twice a day, between 10 a.m. and noon and again between 2 and 4 p.m. This occurred on days two, three and four following surgery, and then again six weeks post-surgery.

Results of the research revealed patients who received manual lymph drainage showed greater active knee flexion at the second assessment time on day four post-surgery, as well as at six weeks post-surgery, compared to patients who did not receive the intervention.


Authors: Jay R. Ebert, Brendan Joss, Berit Jardine and David J. Wood.

Sources: School of Sport Science, Exercise and Health, and School of Surgery, University of Western Australia; Hollywood Functional Rehabilitation Clinic, Nedlands, Perth, Australia. Originally published in November 2013 in Archives of Physical Medicine and Rehabilitation, 94(11), 2103-2111.