Zhao Long, Luo Xiaoling, Wang Duan, Xie Jinwei, Zhou Zongke
West China Hospital of Sichuan University, Chengdu, China.
Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06601-5.
Low-intensity pulsed ultrasound (LIPUS) is a non-invasive physiotherapy that is often utilized to treat swelling and pain caused by musculoskeletal trauma. We aimed to evaluate the efficacy and safety of LIPUS in reducing lower-extremity swelling and pain following total knee arthroplasty (TKA).
This randomized, controlled study evaluated 116 patients undergoing primary TKA, randomly assigning them to either an LIPUS group receiving active LIPUS therapy (0.8 MHz, 1.35 W) or a control group receiving sham treatment. The LIPUS intervention was administered to the operated knee for 25-minute sessions, three times daily for three consecutive days, beginning four hours postoperatively. The primary study outcome measured lower extremity swelling during the first 14 postoperative days, while secondary outcomes included knee pain (assessed by visual analogue scale ranging from 0 to 10 points), Hospital for Special Surgery (HSS) score, range of knee motion (ROM), serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), myoglobin, and complications.
The LIPUS (n = 55) and control (n = 56) groups showed similar baseline characteristics. LIPUS treatment significantly improved clinical outcomes compared to sham treatment, reducing calf swelling by 2.37-2.74%, thigh swelling by 2.76-4.81%, and patellar swelling by 2.30-3.28% (all p < 0.001). Patients receiving LIPUS also reported less walking pain (1.16-2.48 point reduction, p < 0.001) and showed lower inflammatory markers (CRP reduction of 2.53-13.85 mg/L, p = 0.047; IL-6 reduction of 3.64-17.27 pg/mL, p = 0.041). However, the treatment did not significantly affect resting pain, HSS scores, ROM, serum myoglobin levels, or complication rates.
This study found that short-term LIPUS use markedly decreased lower-extremity swelling and walking pain post-TKA, with no major safety concerns. However, future studies are needed to determine the optimal protocol and long-term safety of LIPUS in TKA patients.
低强度脉冲超声（LIPUS）是一种非侵入性物理治疗方法，常用于治疗肌肉骨骼创伤引起的肿胀和疼痛。我们旨在评估LIPUS在减轻全膝关节置换术（TKA）后下肢肿胀和疼痛方面的疗效和安全性。
这项随机对照研究评估了116例行初次TKA的患者，将他们随机分为接受主动LIPUS治疗（0.8MHz，1.35W）的LIPUS组或接受假治疗的对照组。LIPUS干预在术后4小时开始，对手术膝关节进行每次25分钟的治疗，每天3次，连续3天。主要研究结局指标为术后14天内的下肢肿胀情况，次要结局指标包括膝关节疼痛（采用0至10分的视觉模拟评分法评估）、特种外科医院（HSS）评分、膝关节活动范围（ROM）、血清C反应蛋白（CRP）、白细胞介素-6（IL-6）、肌红蛋白水平以及并发症情况。
LIPUS组（n = 55）和对照组（n = 56）具有相似的基线特征。与假治疗相比，LIPUS治疗显著改善了临床结局，小腿肿胀减少2.37 - 2.74%，大腿肿胀减少2.76 - 4.81%，髌肿胀减少2.30 - 3.28%（所有p < 0.001）。接受LIPUS治疗的患者还报告行走疼痛减轻（减少1.16 - 2.48分，p < 0.001），且炎症标志物水平较低（CRP降低2.53 - 13.85mg/L，p = 0.047；IL-6降低3.64 - 17.27pg/mL，p = 0.041）。然而，该治疗对静息痛、HSS评分、ROM、血清肌红蛋白水平或并发症发生率没有显著影响。
本研究发现，短期使用LIPUS可显著降低TKA术后下肢肿胀和行走疼痛，且无重大安全问题。然而，未来需要进一步研究以确定LIPUS在TKA患者中的最佳治疗方案和长期安全性。
