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Marshall et al. | Journal of Clinical and Translational Research 2024; 10(5): 296-306 301
Table 2. Effect size estimates at post-operative days 4, 7, 14, 21, and 42
Outcome Time ICG DCG Hedges’ g effect sizec Between‑group mean
point n Mean SD n Mean SD (95% CI) difference (95% CI) d
difference a difference b
Swelling (%) Day 4 14 27.20 10.65 16 30.27 12.17 0.26 (−0.44 to 0.96) −3.08 (−11.69 to 5.53)
Day 7 11 22.20 10.71 16 21.71 8.98 −0.05 (−0.79 to 0.70) 0.49 (−7.34 to 8.32)
Day 14 13 16.50 12.65 16 18.53 10.72 0.17 (−0.54 to 0.88) −2.03 (−10.93 to 6.87)
Day 21 11 17.03 10.84 16 14.55 7.60 −0.27 (−1.01 to 0.48) 2.48 (−4.81 to 9.77)
Day 42 11 18.84 11.46 15 18.26 9.27 −0.06 (−0.81 to 0.70) 0.58 (−7.81 to 8.97)
Quadriceps Day 21 11 −0.41 0.34 16 −0.46 0.39 0.13 (−0.61 to 0.88) 0.05 (−0.25 to 0.35)
strength (Nm/kg) Day 42 11 −0.21 0.30 15 −0.24 0.40 0.07 (−0.68 to 0.83) 0.03 (−0.27 to 0.32)
Quadriceps Day 21 11 12.23 12.16 15 −3.24 23.20 0.77 (−0.01 to 1.56) 15.47 (0.91 to 30.03)
activation (%) Day 42 11 16.86 13.08 13 7.20 12.99 0.72 (−0.09 to 1.52) 9.66 (−1.42 to 20.73)
WOMAC pain Day 14 10 −1.60 4.55 16 0.13 3.40 0.43 (−0.34 to 1.21) −1.73 (−4.95 to 1.50)
Day 21 11 −2.73 4.17 16 −0.63 3.16 0.57 (−0.19 to 1.33) −2.10 (−5.01 to 0.80)
Day 42 11 −3.64 4.18 16 −2.06 3.21 0.42 (−0.33 to 1.17) −1.57 (−4.50 to 1.35)
Note: mean difference=ICG post-operative day x – ICG baseline; mean difference=DCG post-operative day x – DCG baseline; for clarity, effect sizes have been standardized so
b
a
c
that positive values favor ICG and negative values favor DCG; between-group mean difference = (ICG mean difference) – (DCG mean difference). Abbreviations: ICG: Immediate
d
compression garment; DCG: Delayed compression garment; SD: Standard deviation; CI: Confidence interval; WOMAC: Western Ontario and McMaster universities osteoarthritis index.
satisfaction [3] and early emergency department visits [4,5].
Dissatisfaction after TKA is between 8% and 19%, with
actual rates possibly higher than reported in the literature [54].
In addition, in the first 90 days after TKA, the incidence of
emergency department visits is between 10.8% and 13.8%,
with swelling of the surgical limb being one of the most
common reasons for seeking medical care [4,5]. It remains to
be determined whether minimizing swelling in the early post-
operative period can impact (i) long-term residual swelling and
satisfaction, and (ii) the incidence of emergency department
visits and healthcare costs following TKA.
Nonetheless, the study had several limitations. The primary
aim of this study was to assess the feasibility of ICG among
Figure 3. Changes in swelling over time for immediate compression
garment, delayed compression garment, and elastic thromboembolism- a small sample of TKA recipients. Thus, the study was not
deterrent garment adequately designed to definitively evaluate the efficacy of ICG
compared to DCG. All ESs presented should be interpreted
and ES noted at days 21 and 42 (Table 2). However, there appears in light of this limitation. The 95% CI for all ES includes 0,
to be a trend toward greater quadriceps activation for ICG at both indicating that the true ES could favor either group for all
of these time points (ES = 0.77 and 0.72, respectively). Notably, outcomes. In addition, since we used a historical control
ICG had significantly lower activation compared to DCG at (DCG), there were statistically significant baseline differences
baseline and, thus, more room for improvement. However, this between groups for quadriceps activation and WOMAC pain.
trend is possibly corroborated by the QAB data collected 4 days Future research should focus on randomized controlled trials
after surgery, revealing that 100% of ICG scored ≥ 4 compared to with appropriate power to definitively evaluate efficacy and
only 63% for DCG. Interestingly, Bade et al. [46] found that only minimize baseline differences between groups.
46% of participants scored ≥ 4 on the QAB 4 days after surgery 5. Conclusion
when they received no specific intervention to address swelling or
activation (e.g., no compression garment). This suggests that the The ICG appears feasible after TKA. The effect of immediate
inelastic compression garment might positively affect quadriceps application on peak swelling remains unclear, but this study
activation in the acute post-operative period theoretically by supports the use of an inelastic compression garment to
minimizing swelling and quadriceps AMI. Future research is mitigate total limb swelling in the first 3 weeks after surgery.
warranted to conclusively determine the impact that improved The immediate application demonstrated promising trends
early activation may have on quadriceps strength and function. toward improved early quadriceps activation and pain. Based
Finally, there is a need to determine the impact of an on these results, a future full-scale study will be conducted with
inelastic compression garment on other outcomes that have sufficient power to conclusively evaluate the efficacy of ICG on
been associated with swelling after TKA, for example, patient peak swelling after TKA.

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