Understanding Compression Stockings
Before delving into the technique of how to put on compression stockings after knee surgery, it's crucial to understand what compression stockings are and their role in post-surgery care.
Role of Compression Stockings
Compression stockings are specialized hosiery designed to improve blood flow and prevent the formation of blood clots in the legs. They are recommended after surgery for individuals who are likely to be immobile due to the effects of the operation or due to another medical condition affecting mobility [1].
These stockings work by applying graduated pressure to the legs, with the most compression at the ankle and gradually decreasing pressure towards the top of the stocking. This helps to improve venous return, reducing the risk of blood pooling in the legs and potentially forming a clot, a condition known as deep vein thrombosis (DVT).
The need for compression stockings after surgery is assessed upon admission to the hospital to determine the risk of developing DVT. They should usually be worn as much as possible, day and night, until the patient is able to move around freely after surgery.
Types of Compression Stockings
There are various types of compression stockings available, each designed to meet different needs. These include:
- Knee-high compression stockings: These stockings cover the foot, ankle, and leg up to the knee. They are often recommended after knee surgery to improve blood flow in the lower leg.
- Thigh-high compression stockings: These stockings extend from the foot to the mid-thigh or upper thigh. They are typically used for patients at risk of DVT in the upper leg or thigh.
- Pantyhose-style compression stockings: These stockings cover both legs entirely, from the toes to the waist. They are less commonly used in post-surgery care but can be recommended in certain cases.
When choosing the right compression stocking, it's important to measure the calf circumference at the widest part of the calf and the ankle circumference at the smallest part of the ankle just above the ankle bones [2]. This ensures a proper fit, which is crucial for effective compression therapy.
Remember, while compression stockings play a key role in preventing DVT after surgery, they are just one component of post-operative care. Ensuring adequate fluid intake, early mobilization post-operation, and in some cases, the prescription of anticoagulant medication can also help to decrease the risk of DVT [1].
Choosing the Right Compression Stocking
When it comes to learning how to put on compression stockings after knee surgery, the first step is to choose the right compression stocking. This involves taking accurate measurements and considering the type of stocking that will best suit the patient's needs.
Measuring for Compression Stockings
To choose the right size of compression stocking, one needs to take two critical measurements: the calf circumference at the widest part of the calf and the ankle circumference at the smallest part of the ankle just above the ankle bones.
Accurate measurements ensure the compression stocking fits properly, providing the necessary support without being too tight or too loose. It's essential to remember that the measurements should be taken while the patient's leg is at rest and not swollen.
Above-knee vs Below-knee Stockings
When choosing between above-knee and below-knee stockings, it's important to consider comfort and patient preference. According to a study published on PubMed Central, patients, especially female patients, found above-knee stockings uncomfortable and preferred wearing below-knee stockings after total knee joint replacement.
The same study also noted that there was no statistical difference in knee swelling in the operated knee between above-knee and below-knee stocking groups after total knee joint replacement surgery. This suggests that below-knee stockings can be safely used for patients undergoing total knee joint replacement.
However, the choice between above-knee and below-knee stockings should also consider the patient's physical condition, the type of surgery performed, and the advice of the medical professional. Always consult with a healthcare provider when deciding the best type of compression stocking to use after knee surgery.
Using Compression Stockings after Knee Surgery
Following knee surgery, the use of compression stockings plays a significant role in the recovery process, primarily by helping to prevent deep vein thrombosis (DVT). It's crucial to understand when and how to wear these stockings to maximize their benefits.
When to Wear Compression Stockings
Patients are generally advised to put on compression stockings before getting out of bed in the morning, and to remove them before going to bed at night. The stockings should be worn as much as possible, day and night, after surgery until the patient is able to move around freely. This consistent use helps prevent the development of DVT [1].
The decision to wear compression stockings after surgery is based on assessing the risk of DVT, even if the patient is discharged on the same day as the operation. In addition to wearing compression stockings, reducing the risk of DVT after surgery can be achieved by staying hydrated, moving around soon after the operation, and sometimes by using anticoagulant medication.
How to Put on Compression Stockings
Successfully wearing compression stockings involves following a few essential steps. It's recommended to lie down and elevate the leg for a few minutes before putting on the stockings. This temporary elevation helps to reduce swelling and makes it easier to pull the stockings onto the leg.
Here are some steps to follow:
- Turn the stocking inside out, leaving the foot section right-side out.
- Slide the foot into the foot section.
- Start rolling the stocking up the leg, making sure it's not twisted.
- Ensure the stocking is smooth and flat against the skin, not too tight.
- Use gloves to prevent damaging the fabric.
Patients should check the skin for any irritation or redness, ensuring that the stockings are not too tight. It's important to be gentle when putting on the stockings to avoid tearing or damaging them.
Benefits and Risks of Compression Stockings
When using compression stockings after knee surgery, it is important to understand the potential benefits as well as the risks involved.
Prevention of Deep Vein Thrombosis
One of the key benefits of wearing compression stockings after knee surgery is the prevention of deep vein thrombosis (DVT). DVT is a condition where a blood clot forms in a deep vein, usually in the leg, which can potentially lead to serious complications.
Patients are advised to put on compression stockings before getting out of bed in the morning, and to remove them before going to bed at night. It's recommended to lie down and elevate the leg for a few minutes before putting on the stockings, and to use gloves to prevent damaging the fabric. Patients should check the skin for any irritation or redness, ensuring that the stockings are not too tight.
The stockings should be worn as much as possible, day and night, after surgery until the patient is able to move around freely. This reduces the risk of DVT development [1].
In addition to wearing compression stockings, reducing the risk of DVT after surgery can also be achieved by staying hydrated, moving around soon after the operation, and sometimes by using anticoagulant medication [1].
Potential Side Effects and Complications
While compression stockings are generally safe and effective, they can occasionally lead to side effects and complications. Minor issues may include skin irritation, discomfort, and pain. These were the most frequently reported non-severe medical compression therapy-associated adverse events, according to a systematic literature search of publications up until November 2017 [4].
Rare but severe adverse events can also occur, including soft tissue and nerve injuries. These severe complications are very rare and tend to occur in predisposed patients or during improper use of compression therapy. Other potential risks reported in the literature include skin irritation, pruritus, superficial venous thrombophlebitis at the upper stocking border, and decompensation of heart failure [4].
These potential risks underline the importance of using compression stockings correctly and under the guidance of a healthcare professional. Always consult with your healthcare provider to ensure you are using the stockings correctly and are aware of the potential risks and benefits.
Alternatives to Compression Stockings
While compression stockings are often recommended post knee surgery, there are alternatives that may be just as effective, if not more so. Two such alternatives are the use of anti-clotting medication and the practice of hydration and mobilization.
Anti-clotting Medication
Anti-clotting medication is often prescribed to patients undergoing surgery to prevent the occurrence of venous thromboembolism (VTE). It is particularly recommended for those with a moderate or high risk of VTE. However, recent studies such as the GAPS study suggest that anti-clotting medicine alone may be as effective as using it in combination with compression stockings.
The GAPS study findings imply that the use of compression stockings after surgery might be unnecessary for most patients undergoing planned operations who receive anti-clotting medicine while in the hospital. Therefore, it might be more beneficial to focus on the use of anti-clotting medication, such as heparin, which alone was found to be just as effective at preventing blood clots as the combination of medication and compression stockings [5].
Hydration and Mobilization
Another alternative to compression stockings is the practice of hydration and mobilization. This involves ensuring the patient is adequately hydrated and encouraging them to move around as much as possible post-surgery.
While these practices may not directly replace the role of compression stockings or anti-clotting medication, they can complement these strategies and contribute to the overall prevention of post-surgical complications such as VTE.
The findings from the GAPS study and the efficacy of these alternatives suggest a need to review national and international guidelines for preventing hospital-associated venous thromboembolism (VTE) in light of the risks and costs associated with using compression stockings.
In conclusion, while compression stockings are often recommended as part of post-surgical care, these alternatives may provide effective ways to prevent complications such as VTE, particularly in patients who are already receiving anti-clotting medication.
Recent Studies on Compression Therapy
The use of compression stockings after knee surgery has recently been the subject of research to evaluate its effectiveness and necessity. This section discusses the findings of the GAPS study, a significant study on this topic, and the implications for current practice.
GAPS Study Findings
The GAPS study, conducted by the National Institute for Health Research (NIHR), explored whether the use of compression stockings was necessary for patients at moderate or high risk of blood clots undergoing planned surgery. The study found that anti-clotting medicine alone was as effective as using it in conjunction with compression stockings. This suggests that compression stockings might not be necessary for these patients [5].
The study also indicated that the use of compression stockings after surgery is unnecessary for most patients undergoing planned operations who receive anti-clotting medicine while in the hospital.
Implications for Current Practice
The findings of the GAPS study have significant implications for current practice. Despite guidelines recommending the use of graduated compression stockings in combination with anti-clotting medicines for patients with a moderate or high risk of venous thromboembolism (VTE) undergoing planned surgery, many clinicians are unconvinced about the necessity of compression stockings in addition to medication [5].
The GAPS study findings suggest a need to review national and international guidelines for preventing hospital-associated venous thromboembolism (VTE) in light of the risks and costs associated with using compression stockings [5].
This could lead to changes in how post-operative care is managed, particularly for patients at moderate or high risk of blood clots. As always, patients should consult with their healthcare provider to understand the best approach to their post-operative care based on their individual health circumstances and the latest research findings.
References
[1]: https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/how-long-should-i-wear-compression-stockings-after-surgery/
[2]: https://vivewear.com/pages/compression-sock-sizing-chart
[3]: https://pubmed.ncbi.nlm.nih.gov/33339752/
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383414/
[5]: https://evidence.nihr.ac.uk/alert/most-patients-undergoing-planned-surgery-do-not-need-compression-stockings/
