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300 Marshall et al. | Journal of Clinical and Translational Research 2024; 10(5): 296-306
Table 1. Participant baseline characteristics
Characteristic ICG DCG p‑value a
Median (IQR) Mean (SD) Median (IQR) Mean (SD)
Age, years 64.5 (15.0) 62.3 (8.3) 65.0 (10.0) 64.7 (7.1) 0.40
BMI (kg/m ) 29.5 (9.4) 28.6 (5.2) 28.9 (7.3) 29.8 (4.9) 0.66
2
Swelling (%) 0.6 (8.4) 0.3 (8.0) −1.7 (5.0) -2.5 (4.9) 0.35
Quadriceps strength (Nm/kg) 0.9 (0.4) 1.1 (0.5) 1.0 (0.6) 1.2 (0.5) 0.72
Quadriceps activation (%) 57.9 (31.9) 61.3 (18.4) 84.6 (14.5) 79.6 (16.4) 0.01 b
WOMAC pain 9.0 (5.0) 9.6 (3.7) 7.5 (2.5) 7.4 (2.6) 0.04 b
Note: p-value, Wilcoxon rank sum; statistically significant at p<0.05.
a
b
Abbreviations: ICG: Immediate compression garment; DCG: Delayed compression garment; IQR: Interquartile range; SD: Standard deviation; BMI: Body mass index; WOMAC: Western
Ontario and McMaster Universities osteoarthritis index.
underwent manipulation under anesthesia (MUA) to address participants would be awake each day with the surgical limb
knee ROM limitations. On average, participants indicated they in a gravity-dependent position and potentially accumulating
wore the garment for 11 ± 2 h/day (95% CI: 10 – 12). They swelling. Our findings suggest that a 12-hour wear time may
were only adherent to wearing the garment for the prescribed not be feasible, but also that 12 hours may not be necessary,
12-h wear time, on average, 64 ± 37% of the time (95% CI: since swelling mitigation in ICG was similar to that found in
43–85%). Median satisfaction with the garment was 5/5 (i.e., DCG. Future studies should consider a shortened daily wear
very satisfied) on the five-point Likert scale (range: 4 – 5). time to better accommodate participants’ natural daily waking
hours and to improve adherence. While it is unfortunate that
3.2. Initial efficacy
one participant experienced DVT while enrolled in this study, it
The mean and SD for all outcomes at all-time points are listed is not appropriate to assume a causal relationship between the
in Table S2. A summary of ES at all-time points can be found two. DVT after TKA occurs at a rate of 0.5% – 0.9% [50,51],
in Table 2. For swelling, a medium and a small ES were found suggesting that this event may be due to chance alone. Similarly,
in favor of ICG at days 4 and 14, respectively. Conversely, rates of MUA after TKA range from 0.6% to 4.2% [52,53].
ES for swelling at days 7, 21, and 42 were found in favor of Both of the participants in this study who wore the garment
DCG. ES for all other outcomes and time points favored ICG. while sleeping went on to have MUA, but this does not imply
Small ES were found for quadriceps strength and medium ES causality. In addition, no DVTs or MUAs occurred in the DCG
for quadriceps activation at days 21 and 42. Medium ES was group [36]. Nevertheless, future studies should report adverse
found for WOMAC pain on days 14, 21, and 42. A significantly event rates with particular attention to DVT and MUA.
greater proportion of ICG scored ≥ 4 on the QAB compared to The ES for swelling at days 4 and 14 favored ICG, while the
DCG (100% vs. 63%, respectively; p = 0.02). remaining time points favored DCG. When looking at the raw
data, the ICG and DCG groups appear similar in their ability
4. Discussion to mitigate swelling compared to a historical control cohort
This study evaluated the feasibility and initial efficacy of that only wore elastic T.E.D. hose (Figure 3) [2,36]. While
applying an inelastic compression garment in the operating it is unclear if ICG was able to mitigate peak swelling to a
room immediately after TKA. The effect of immediate greater extent than DCG, our findings demonstrate the effect
application (ICG) on peak swelling remains unclear, but this that an inelastic garment can have on swelling after TKA. In
study supports the use of an inelastic compression garment to addition, early application would still be preferred in future
mitigate total limb swelling in the first 3 weeks after surgery. studies, given the trend toward improved activation and the
The immediate application demonstrated promising trends ease of donning the garment while the patient is still within
toward improved early quadriceps activation and pain. Future their surgical episode of care. Applying the garment 3 – 4 days
research is warranted to conclusively evaluate efficacy as our after surgery necessitates a clinic visit, which may not align
small sample size was not designed to do so. with typical care pathways.
The ICG appears feasible after TKA. All ICG participants There appears to be a trend towards better WOMAC pain
indicated they were completely or somewhat satisfied with scores for ICG than DCG, with medium ES ranging from 0.42 to
the compression garment, that is, 4 – 5/5 on the Likert scale, 0.57 for days 14 – 42 (Table 2). This should be interpreted with
which is consistent with the satisfaction reported in DCG [36]. caution, as ICG had significantly higher pain scores at baseline
Average adherence to the prescribed wear time of 12 hours per than DCG (mean: 9.6 vs. 7.4, respectively) (Table 1), suggesting
day over the intervention period was only 64% for ICG. Instead, that ICG had more room for improvement. Future research
participants recorded wearing the garment for 10.9 hours on should also examine narcotic pain medication usage to better
average per day, with some indicating that they were simply assess the relationship between ICG and pain amelioration.
not awake for 12 hours. The 12-hour wear time was chosen The ICG does not appear to have had a significant effect on
arbitrarily based on an estimate of the amount of time that quadriceps strength with small between-group mean differences

DOI: http://doi.org/10.36922/jctr.24.00026