“Do I always need drainage?”

Improved chances of healing: during the pre-operative and post-operative management of outpatient arthroscopic procedures related to the knee, Christian Teusch, Specialist in Orthopedics, Trauma Surgery, and Sports Orthopedics as well as Attending Physician at SRH Wald-Klinikum Hospital in Gera, combines the potential of compression and orthopedic stabilization.

“I’m always trying to integrate modern treatment concepts and options in my daily work to get the best possible outcome for my patients,” Christian Teusch explains. In 2023, the Specialist in Orthopedics and Trauma Surgery/Sports Orthopedics started at SRH Wald-Klinikum in Gera after working as a trauma surgeon/orthopedist at Merzig Hospital (Saar) for many years. As with his work at the medical treatment center of the SRH polyclinic, he specializes in joint-reconstructing procedures relating to the shoulder, elbow, and knee. His guiding principle: “I want to avoid drainage after arthroscopic procedures by implementing effective post-operative swelling management, thus mobilizing my patients more quickly.” His concept: before surgery, he prescribes compression stockings to his patients with which the patient is fitted on the day of surgery, right there in the operating theater. Teusch, born in Saarland, learned this procedure as early as 2016 when working in endoprosthetics. In Gera, he transferred this method to knee arthroscopy and now uses it successfully as an integral part of his treatment regime for meniscus surgery, cruciate ligament reconstruction, MPFL reconstruction, and cartilage as well as tendon surgery. “Wound healing is certainly more effective when using compression stockings. Add to this swelling management. If I want to avoid drainage, I have to make sure that during surgery and beyond, swelling does not occur. We wrap the leg in advance.

“I want to avoid drainage after arthroscopic procedures by implementing effective post-operative swelling management, thus mobilizing my patients more quickly.”

Christian Teusch

Then, a compression class 2 thigh-high stocking fulfills this function in my treatment regime,” Christian Teusch elaborates. While a medical compression stocking suffices after meniscus surgery as an aid in follow-up care, more complex reconstruction procedures often require the interaction of a compression stocking with a hard-frame brace that stabilizes according to the 4-point principle.

Limiting flexion with a brace

“In the first six weeks after cruciate ligament surgery, I need flexion limitation of 90 degrees in a frame system. This is the main reason for using a brace,” Christian Teusch clarifies. “Patients must be mobilized early in an outpatient setting. That’s why it’s important that the brace is fitted as early as the operating theater,” the specialist explains. While the healing process progresses, the brace will protect patients from bending their knees too much too soon. Those who undergo cruciate ligament surgery are allowed to bend their knee 90 degrees from the first day. After kneecap procedures (e.g. MPFL), extension should be limited to 15° and flexion to 75°. Following cartilage surgery, the knee will be fully immobilized for two weeks, then flexion is gradually increased by 30 degrees every two weeks. He particularly values the semi-flexible SecuTec Genu Flex frame brace for use after arthroscopic procedures.

“The adaptability of its Flex-Links to thigh and lower leg circumferences ensures that it encloses the femur particularly well and has a great fit overall,” says Christian Teusch, speaking from experience. There is no need to worry about a lack of stability: “Once all straps have been closed properly, it fits perfectly and is absolutely stable.”

The brace is positioned on the stocking just as firmly as on the skin, and patients comment on an increased sensation of stability.

Christian Teusch

The best conditions for the patient and surgery

The use of a brace and medical compression stockings begins even before surgery. “As soon as a patient arrives at the medical treatment center, we’re starting with pre-operative care. In cases of major injuries, such as torn cruciate ligaments, that cannot be operated on immediately, patients wearing a brace are able to safely and effectively deal with everyday activities until the surgery. So that patients can continue to wear the brace for the six to eight weeks after surgery, I issue a follow-up prescription for it specifying the surgery date,” Christian Teusch reports. The physician is particularly intent on creating the best possible outset for the surgery. “The implementation of physiotherapy and lymphatic drainage is difficult to calculate from a budgetary point of view before surgery. We therefore prescribe compression stockings in advance as a support to reduce post-traumatic swelling as much as possible until the date of surgery.” Patients will bring these stockings and the brace, if applicable, to the surgery, and have them fitted immediately afterward. The wounds are covered with compresses and plasters, and the stocking is donned using a donning aid. Carefully applied over the plasters, the stocking will fit firmly until the dressing has to be changed next, without causing uncomfortable rubbing.

“This means drainage can often be avoided and the risk of infection is reduced,” says Christian Teusch, describing the major advantages of medical compression stockings, particularly in the context of increasing outpatient treatment. He does not mind that the brace sits right on the compression stocking. “On the contrary: this combination even has advantages. The brace is positioned on the stocking just as firmly as on the skin, and patients comment on an increased sensation of stability. They’re actually happier with their products. The latter may have psychological reasons, of course. They just feel cared for all-round.” Christian Teusch will see his patients on the first, fifth and twelfth day after surgery for check-ups – and depending on the surgery, at certain intervals beyond that. “I’ll also check and potentially adjust the fit of the medical products as well as the movement limitation of the brace,” the specialist explains. According to the physician, an advantage of the combination of compression and brace that should not be underestimated is the faster mobilization of the joint. Patients have reported that both medical products make training at home on the dynamic splint more comfortable, bridging the gap until physiotherapy or outpatient rehabilitation starts. 

Compression until the load phase begins

When prescribing medical products, Christian Teusch makes sure he issues separate prescriptions. Whether brace, medical compression stocking, or a foot orthosis which he will also add for treating patellar tendons, for example – with individual prescriptions, patients have the choice from which medical retailer they want to obtain their aids.  Furthermore, every medical product belonging to a product group requires a separate prescription and separate diagnosis in order to be billed. When issuing a prescription, he specifies the 7-digit code. “I will name the product that I feel is the most suitable as an example.” He usually prescribes compression class 2 compression stockings. He values the VenoTrain soft S which does not slip and can be donned easily, thanks to the spacious Easy heel. The art of follow-up care is being able to motivate patients to continue wearing the compression stockings even after the sutures have been removed. “They can return to activities much faster and they feel fit. Many patients tend to develop swelling in the area of the lower leg when increasing load. That’s why I want my patients to continue wearing compression products during the first phase of increasing load.”

Pictures: Udo Schönewald