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Meta-Analysis
. 2024 Jan 2;25(1):30.
doi: 10.1186/s12891-023-07153-8.

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials

Hongyuan Lu #  1   2 , Quanwei Shao #  3 , Wenyao Li #  4 , Fei Li  2   5 , Weiyi Xiong  5 , Kunpeng Li  6 , Wei Feng  7   8
Affiliations
Meta-Analysis

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials

Hongyuan Lu et al. BMC Musculoskelet Disord. .

Abstract

Background: Total knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR.

Methods: A search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence.

Results: In total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083).

Conclusions: Based on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.

Keywords: Edema; Manual lymphatic drainage; Pain; Range of motion; Total knee replacement.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram of study selection
Fig. 2
Fig. 2
Risk of bias graph showing each risk of bias item as percentages across all included studies
Fig. 3
Fig. 3
Risk of bias summary for included studies
Fig. 4
Fig. 4
Forest plot of knee flexion range of motion
Fig. 5
Fig. 5
Forest plot of knee extension range of motion
Fig. 6
Fig. 6
Forest plot of knee joint pain assessed by VAS and NRS. VAS: Visual Analogue Scale; NRS: Numerical Rating Scale
Fig. 7
Fig. 7
Forest plot of knee edema assessed by thigh, calf, and ankle circumferences
Fig. 8
Fig. 8
Funnel plot of knee joint pain after TKR surgery. TKR: Total knee replacement
Fig. 9
Fig. 9
Sensitivity analysis of knee joint pain after TKR surgery. TKR: Total knee replacement
See this image and copyright information in PMC

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