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TECHNOLOGY


device had not been oedema management. The discovery that it could positively impact oedema reduction was a stroke of luck. While working with orthopaedic clinical partners, who were exploring use of the device for post-operative venous thromboembolism (VTE) prevention, its effect on oedema reduction was first observed. This led to the completion of several studies, including a pre-operative, prospective and retrospective audit of clinical practice, in partnership with the James Cook University Hospital, part of the South Tees Hospitals NHS Foundation Trust in Middlesbrough. The clinical team, led by Mr Paul Baker, orthopaedic consultant surgeon10


, measured the time to surgery in 20 ankle facture patients requiring surgical fixation and their tolerance to the geko device.


The results showed accelerated time to theatre – a statistically significant two- day reduction in readiness for surgery (on average) – with all patients reporting the geko device as well tolerated. Noticeably, patients were able to mobilise more easily, for toilet visits or visits the coffee shop, with the device still active. Previously, IPC hoses and leads would have tethered these patients to the bed, requiring a nurse to first unplug the leads. A published randomised controlled trial (RCT) by Wainwright et al14


followed,


demonstrating the geko’s post-operative oedema control credentials. The study compared the effect of the device to TED Stockings (standard care) in 40 total hip replacement patients and reported the prevention of oedema build-up post- operatively – again, with all patients reporting the device as well tolerated. In a US study, the geko device is also being used by patients in the home. Participating hospitals are fitting the device in the recovery room to the affected limb, immediately post-surgery, for 24 hours. When the patients are ready to go home, they are then trained to self-apply the device and are provided with treatment packs for nine days, to maintain oedema prevention. The device has also found success outside of orthopaedics. A published study from Lawson Health Research Institute (LHSC), Ontario, Canada, led by Dr. Alp Sener15


, found the geko device is


effective in reducing swelling after kidney transplantation. The RCT, spanning two years and 221 transplant patients, compared the geko device impact to compression stockings and IPC, for six days wear following surgery.


The results show that use of the device alone increased urine output by 27% and lowered weight gain by over a kilogram. With more urine produced and less fluid retention, patients experienced 31% less oedema and the duration of costly hospitalisation was


AUGUST 2021


shortened by more than one day after kidney transplantation, compared to standard care.


Conclusion


This existing data and an ongoing programme of studies serve to demonstrate efficacy of the device and offers, for the first time, an effective intervention where, previously, few or no tools have been available. It is easy to use and can provide clinicians and patients with the means to manage both surgical and non-surgical related oedema, for accelerated patient intervention, earlier patient discharge and enhanced patient recovery.


flow in the deep veins of the lower limb using the geko neuromuscular electro-stimulation device. International Angiology 2016 August;35(4):406-10.


13. Tucker A, et al. Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve. Int J Angiol. 2010 Spring; 19(1): e31–e37. doi: 10.1055/s-0031-1278361.


14. Wainwright TW, et al. Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders Volume 12: 1–6 © The Author(s) 2019.


CSJ


References: 1. Mayo Clinic https://www.mayoclinic.org/diseases- conditions/edema/symptoms-causes/syc- 20366493.


2. Kluga K, et al. Improving Orthopedic-Related Postoperative Edema Management in a Rehabilitative Nursing Setting. Rehabil Nurs. May/Jun 2019;44(3):151-160. doi: 10.1097/ rnj.0000000000000104.


3. NHS long-term plan: https://www.longtermplan. nhs.uk/


4. Rohit A, et al. Early versus late surgery for closed ankle fractures. Journal of Orthopaedic Surgery 2015;23(3):341-4.


5. Keehan R, et al. Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture. Foot Ankle Surg. 2013 Sep;19(3):173-6. doi: 10.1016/j.fas.2013.04.004. Epub 2013 May 19.


6. Yaning S, et al. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture. Medicine (Balimore). 2018 Feb; 97(7): e9901. Published online 2018 Feb 16. doi: 10.1097/ MD.0000000000009901.


7. Arverud E, et al. Adjuvant compression therapy in orthopaedic surgery – an evidence-based review. European Orthopaedics and Traumatology, volume 4, pages49–57 (2013).


8. Rice DA, et al. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects. Arthritis research and therapy. Volume 12, Article number: R151 (2011).


9. Kelly M P, et al. Reasons for Ninety-Day Emergency Visits and Readmissions After Elective Total Joint Arthroplasty. The Journal of Arthroplasty. Volume 33, issue 7, P2075-2081, July 01, 2018.


10. Mahmood I, et al. Neuromuscular Electrostimulation Device Reduces Preoperative Edema and Accelerates Readiness for Theater in Patients Requiring Open Reduction Internal Fixation for Acute Ankle Fracture. Techniques in Foot & Ankle Surgery, 2019.


11. Thacoor A, et al. Cryotherapy following total knee arthroplasty: What is the evidence? Journal of Orthopaedic Surgery 27(1) 1–6 ª The Author(s) 2019.


12. Nicolaides A and Griffin M. Measurement of blood WWW.CLINICALSERVICESJOURNAL.COM l 39 About the author


Andrew Thelwell is chief commercial officer at Sky Medical Technology. He has been with the company for more than five years and has more than 30 years’ experience in in medical technology. Sky Medical Technology is the parent of Firstkind, a UK-based medical devices company. Through the mechanism of neuromuscular electrostimulation, Sky has developed a non-invasive technology platform, OnPulse, which is embedded in its geko device. Sky’s products are tailored to different medical application areas, selling through strategic partnerships or distributors in each major clinical area. Clinical areas of focus include life threatening blood clots, complications related to swelling after orthopaedic surgery and vascular conditions related to wound healing.


15. Sener A, et al. Use of a Muscle Pump Activator Leads to Improved Lower Limb Edema, Lower Limb Blood Flow, and Urine Output Compared With Standard TED Stockings and Compression Devices Following Kidney Transplant: A Randomized Controlled Trial. Transplantation Proceedings. Volume 51, Issue 6, July–August 2019, Pages 1838-1844.


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