Use of the Physicool Bandage for TKR patients In Nevill Hall Hospital, NHS Wales-

Patients who have their knees replaced consistently complain of a painful hot swollen knee for many months after their surgery. Anything that helps with this is a useful addition to post op care, and can contribute to an earlier discharge from hospital.

Post operative cooling has been proved to improve post op pain and function. The Cryo Cuff device has been used in RGH and OSU for at least 15 years at a cost of approximately £45 per patient.  Patients in Nevill Hall are disadvantaged as we do not use any form of post op cooling.

We have found an alternative simple effective form of cooling a patient’s knee post TKR. This method performs more efficiently than the cryo cuff and is available at a fraction of the cost.  It is a crepe bandage, soaked in an alcoholic solution. The product is called Physicool. As the solution evaporates it cools the surface of the skin. The patients are also given a 500ml bottle of the solution to‘re-charge’ the bandage. They are able to apply the bandage on day one post surgery after the large theatre dressing has been removed. The patients are able to mobilise fully whilst wearing the bandage and can put it on unaided.

The bandage stays wet for approximately 2 hours and will then need removing and re-charging with the solution. This is done by re-rolling it and placing it in the re-sealable pouch and using 40/50 sprays of the solution directly into the pouch. Patients consistently report how soothing the bandage is and how much more comfortable it makes their knee.

We have carried out pain scores with our TKR patients and have compared them with patients using the new system. Pain scores run from 0 (no pain) to ten (worst pain ever). The scores show a reduction in the score on a daily basis with the Physicool patients. The pain scores from patients who did not receive Physicool remained static usually toward the upper end of the score, i.e. more pain for longer.

This is only a very small trial; however it shows a consistent reduction in pain and swelling for the patients who are using the Physicool system. This system enables patients to mobilise faster and with less pain, and possibly to be discharged earlier.

Mr Simon Garrett a consultant orthopaedic surgeon working at Dorset County Hospital has done a large randomised controlled trial comparing the Physicool bandage with Cryo-Cuff. There is a statistically significantly better outcome for the Physicool patients. We have his presentation to the EFORT conference in Berlin available.

The company have given us the product freely to trial, and at least four of the surgeons have used it on their TKR patients, all have received excellent feedback from their patients regarding its efficacy in pain reduction.

We would very much like to be able to offer this new product to our patients as at present there is an inequity between patients operated on in the south and the north, as we are unable to offer them cryo-cuff to use either.

Physicool Ltd. will supply ABHB with the bandages each bandage and 500ml coolant at cost that will be a vast saving on traditional forms of treatment, last year we performed 420 TKR within Nevill Hall.

At the moment it is difficult for the patients to buy replacement bottles of coolant spray locally. So it has been suggested that we stock the spray in pharmacy and sell it to the patients at a price that is above our cost but much reduced from the RRP. This will make a profit and could completely offset the cost of the bandage to the healthboard.

References;
Enhancing postoperative rehabilitation using a new cooling appliance in knee arthroplasty patients.
Mumath, A  Barrett, M & Garrett, S .  EFORT Conference Berlin 2012