Ask an answerable question (PICO)：
Degenerative osteoarthritis in knee is the most common musculoskeletal disease in the elder population and total knee replacement is the main treatment option. The knee range of motion after operation is often evaluated as an effective indicator. Some orthopedic surgeons advised elastic bandage compression on the operative site within 24 hours after operation to decreasing swelling and pain and improving range of motion. However, there was no consensus in this postoperative management and doubt by the patients. Thus, we ask a clinical question “Will the usage of elastic bandage compression on the operative site within 24 hours after total knee replacement can lead to improving knee range of motion?” We hope to provide clinical treatment guidance under evidence-based review.
The Method and Analysis of Literature Review：
In this review, we follow the first 3 steps of the evidence-based nursing 5As process: asking, acquire, appraisal, and propose a PICO question “Will the usage of elastic bandage compression on the operative site within 24 hours after total knee replacement can lead to improving knee range of motion?” We systematically searched Airiti Library, Index of the Taiwan Periodical Literature System databases, Cochrane Library, PubMed/MEDLINE, CINAHL, ProQuest, Epistemonikos databases under setting the MeSH term and synonyms related to “total knee replacement” and “elastic bandage” in English and Chinese databases. We included 114 papers with search strategies of OR and AND by Boolean logic and restricted to meta-analysis, systemic review, and randomized controlled trial. After excluding papers with duplicate articles and without explored the effect of the postoperative range of motion, we included 3 randomized controlled trials for further evaluation.
Critical Appraisal：
In our review, we used the 2020 CASP randomized controlled trial standard checklist as the tool for critical appraisal. All experimental groups in these 3 studies underwent elastic bandage compression on the operative site within 24 hours after operation in comparison to without elastic bandage use in the control group. As the result of critical appraisal, all 3 studies indicated no significant difference in postoperative knee range of motion, incidence of knee swelling, and subcutaneous hematoma. In addition, 1 study showed compression with elastic bandage significantly increase pain score and the other one showed significantly increase discomfort. All 3 studies are level 2 evidence in Oxford centre for evidence-based medicine (2011).
Results, Conclusions and Recommendations：
As the result of 3 randomized controlled trials, usage of elastic bandage compression on the operative site within 24 hours after total knee replacement can’t improve knee range of motion, decrease postoperative swelling, pain and complications. One of studies showed compression with elastic bandage significantly increase pain score and the other one showed significantly increase discomfort on the first day after operation. Thus, we don’t encourage routine use of elastic bandage compression on the operative site within 24 hours after total knee replacement. We suggest consider the current best evidence and discuss with the medical team in order to improve postoperative recovery, comfort, and satisfaction.
