TECHNOLOGY
muscle strength and reducing input to the surrounding muscles by activating mechanisms within the central nervous system that can change the discharge of sensory receptors preventing the quadriceps muscle from being fully activated, thereby causing muscle weakness and loss of muscle function.8
Although patients are being discharged earlier than in the past, a published study by Kelly et al, which sought to identify common reasons for 90-day emergency department (ED) visits following total joint arthroplasty (TJA), reports post-operative swelling as one of the top three surgery related reasons for post-operative complications, following total knee arthroplasty (TKA) and total hip arthroplasty (THA). One in ten patients return to ED within 90 days of TJA, incurring costs for clinician time and diagnostic scans/ tests to determine and prescribe appropriate treatments.9
How do we tackle oedema? In the UK, the current pre-operative standard of care in ankle-facture patients requiring surgical fixation is elevation plus a backslab plaster cast, either alone or with external fixation, or elevation plus a backslab plaster cast with mechanical pneumatic compression (IPC) fitted beneath the cast. IPC is a boot- like cuff that compresses the leg to increase blood flow. It is not suitable, however, for all patients due to vascular disease, fragile skin, or complex limb injury and fitting IPC beneath a backslab is also uncomfortable.10 IPC is also used post-operatively following
TJA surgery, as is the non-pharmaceutical option, cryotherapy, which has evolved from simple ice sleeves (or gel packs), to more refined devices employing electronically
controlled cold fluid or air circulation. Both are used in the immediate post-operative period and while they provide some benefits, their use is controversial2,11
and
both require resources to correctly fit the devices. Furthermore, the pneumatic pumps that operate the cuffs are not always readily available.
Until now, there have been few tools to
address the complications which can delay surgery, impede wound closure, decrease muscle strength and stall rehabilitation. With this in mind, Sky Medical Technology has developed the geko device – a small electronic medical technology device about the size of a wristwatch.
How the geko device provides a solution for oedema To solve this oedema burden, consider the vascular nature of the condition, and how increasing blood flow in a lower limb can provide the key for swelling reduction pre- and post-operatively and in non-surgical patients.2
Through its mechanism of neuromuscular electrostimulation, the battery powered geko device is applied non-invasively over the common peroneal nerve at the side of the knee. It gently stimulates the nerve, once every second, activating the calf and foot muscle pumps – resulting in an increase in the blood flow in the deep veins of the calf,12 at a rate equal to 60% of walking,13
without
a patient having to move. This mechanism of action – the combination of calf muscle activation and blood flow increase – is clinically proven to reduce both fluid leakage in the capillary bed and to enable oedema clearance by local reabsorption of excess interstitial fluid via the vasculature and lymphatic system.10,14 Initially, the intended use of the geko
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WWW.CLINICALSERVICESJOURNAL.COM AUGUST 2021
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