Does Manual Lymphatic Drainage Improve Recovery After Total Knee Replacement?

Manual Lymphatic Drainage (MLD) is often used to reduce postoperative swelling after a Total Knee Arthroplasty, but does the evidence support its routine use?

A recent systematic review analyzed whether MLD could reduce postoperative edema, relieve pain, and improve knee range of motion during the first weeks after surgery.

What did the review find?

The overall results showed no clear clinical advantage of MLD over standard postoperative care.

• Swelling (edema): There was no consistent evidence that MLD reduced postoperative swelling better than conventional rehabilitation. The available studies were too heterogeneous to draw firm conclusions.

• Pain: Most studies found no significant long-term reduction in pain. However, a few reported a short-term pain-relieving effect immediately after treatment sessions.

• Range of motion: A pooled analysis found no significant improvement in knee mobility compared with standard physiotherapy, although two individual studies reported small benefits.

Importantly, no adverse effects of MLD were reported, confirming that the technique is safe when performed appropriately.

The authors also highlighted important limitations of the existing research. Most studies included relatively small patient groups, used different treatment protocols, and measured swelling in different ways, making comparisons difficult. Larger, well-designed studies are still needed.

What does this mean for physiotherapists?*

No clear clinical superiority of MLD over the comparator interventions was found with regard to

• reducing postoperative edema

• alleviating pain

• improving range of motion following knee replacement surgery.

However, the available evidence is not sufficiently reliable. Given its excellent safety profile and the temporary symptomatic benefits observed in some studies, MLD may be considered as a complementary intervention within a multimodal rehabilitation protocol for selected patients.

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Source: Davide, P., Christian, C., Niccolo’, L., & Giulia, M. (2026). Effectiveness of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Systematic Review. Journal of Clinical Medicine, 15(14), 5575. https://doi.org/10.3390/jcm15145575

*Disclaimer: This document contains a summary and interpretation of scientific material and does not constitute an official representation of the original publication. No guarantee is made regarding the accuracy, completeness, or interpretation of the information presented. All responsibility for verifying the content and drawing conclusions from the original source rests with the reader. I expressly disclaim any liability for errors, inaccuracies, omissions, or any direct or indirect consequences arising from the use or reliance on this document.