Elsevier

The Knee

Volume 9, Issue 3, September 2002, Pages 225-228
The Knee

The use of knee splints after total knee replacements

https://doi.org/10.1016/S0968-0160(01)00152-1Get rights and content

Abstract

The aim of this randomised prospective study was to establish whether the use of knee splints following total knee replacement is necessary. The study included 81 patients undergoing total knee replacement who were randomised into a ‘splint’ and a ‘no splint’ group post-operatively. The following parameters were recorded: The range of movement pre-operatively, 5 days post-operatively and 6 weeks post-operatively; the length of time to straight leg raise; the blood drained from the wound; and the amount of post-operative analgesia required. We found that patients in the ‘no splint’ group achieved significantly greater flexion at 5 days and 6 weeks post-operatively but drained significantly more blood from the wound. Transfusion requirements were similar in the two groups. There was no other significant difference in the parameters measured between the two groups. In conclusion we found no evidence to advocate the use of knee splints following total knee arthroplasty.

Introduction

Knee splints are extensively used after knee injuries [1], [2], [3]. The use of knee splints following total knee replacements is routine practice in many centres in the UK. However, there is no clear evidence in favour of knee splintage in the early post-operative period. Arguments in favour of knee splints include better wound healing, greater extension and less analgesic requirements. Although various studies have looked at the effects of Continuous Passive Motion [4], [5], we found no papers that investigated the need for knee splints following total knee replacements.

The aim of this randomised prospective study was to establish whether the use of knee splints following total knee replacement is necessary.

Section snippets

Methods

The study was performed at North Manchester General Hospital from July 1999 to August 2000 and was approved by the ethics committee. The study involved 81 consecutive patients undergoing total knee replacement. All patients signed a consent form before participating in the study and were randomised into two groups using a ‘sealed envelope technique’. The closed envelopes reading ‘splint’ or ‘no splint’ were kept outside theatres and were opened by a member of the nursing staff only after

Pre-operative features (Tables 1 and 2)

Forty-two patients had knee splints post-operatively and 39 did not. The two groups were well matched in terms of age and gender. There was no significant difference in pre-operative flexion and extension between the two groups.

Post-operative knee movements (Table 2)

When comparing the two groups there was no difference in knee extension at 5 days or 6 weeks. Patients in the ‘no splint’ group achieved significantly greater flexion at both 5 days and 6 weeks.

Straight leg raise (Table 3)

There was no significant difference between the groups as to when the

Discussion

Prior to this study all patients that underwent total knee replacements at our unit were put in knee splints in the early post-operative period. However, there is no evidence to suggest that these splints are beneficial and some hospitals do not use them at all. This study showed no evidence to support claims that knee splintage in extension in the early post-operative period is useful in pain control, reducing wound complications or achieving greater extension.

The aim of total knee replacement

References (19)

  • K.R. Sehat et al.

    How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account

    Knee

    (2000)
  • H. Maenpaa et al.

    Patellar dislocation. The long-term results of nonoperative management in 100 patients

    Am. J. Sports Med.

    (1997)
  • J.W. Pritchett

    Non-operative treatment of widely displaced patella fractures

    Am. J. Knee Surg.

    (1997)
  • D. Tylman et al.

    Long-term results of functional treatment in intraarticular knee fractures and multifragment fractures of the shaft of femurs

    Clin. Orthop.

    (1991)
  • R.D. Coutts et al.

    The role of continuous motion in the post-operative rehabilitation of the total knee patient

    Orthop. Trans.

    (1982)
  • R.D. Coutts et al.

    The effect of continuous passive motion in total knee rehabilitation

    Orthop. Trans.

    (1983)
  • D.B. Kettelkamp et al.

    An electrogoniometric study of knee motion in normal gait

    J. Bone Joint Surg. (Am)

    (1970)
  • K.N. Laubenthal et al.

    A quantitative analysis of knee motion during activities of daily living

    Phys. Ther.

    (1972)
  • I.A. Harvey et al.

    Factors affecting the range of movement of total knee arthroplasty

    J. Bone Joint Surg. (Br)

    (1993)
There are more references available in the full text version of this article.

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