A clinical study published in The Journal of Bone & Joint Surgery reports that the treatment with Diosmin, a flavonoid supplement extracted from citrus fruits, can reduce knee and leg swelling and alleviate pain associated with knee total knee arthroplasty (TKA).
„The use of Diosmin after TKA reduced swelling and pain in the lower extremities during movement and was not associated with an increased incidence of short-term complications related to the outcomes examined,“ as stated in the new study by Pengde Kang, PhD, MD, from Sichuan University, Chengdu, China, and colleagues.
Potential New Approach for Alleviating Painful Swelling After TKA
Swelling is a common problem in patients undergoing TKA and contributes to pain and patient dissatisfaction. Various measures have been proposed to reduce swelling, including rest, ice packs, and compression bandages, with mixed success. Currently, there are no effective medications to reduce swelling after TKA.
Diosmin is commonly used in combination with a related flavonoid called Hesperidin to reduce limb swelling in patients with venous disease. Although Diosmin is not approved as a prescription medication in the U.S. and Europe, experience suggests it is well-tolerated and has low toxicity. Based on these features, the researchers designed a clinical study to evaluate the efficacy and safety of Diosmin in patients undergoing TKA.
The explorative study included 330 patients who underwent TKA in 13 university-affiliated hospitals. The patients were randomly assigned to a treatment group and received a 14-day course of Diosmin starting from the first postoperative day, or to a control group that did not receive the study treatment. Both groups received standard pain medication.
Swelling at specific sites was measured 1, 2, 3, and 14 days after the surgery and compared between the Diosmin and control groups. In addition, pain scores, knee function, complication rates, and blood levels of certain inflammatory markers (C-reactive protein and interleukin-6) were assessed.
Diosmin Reduces Swelling and Pain during Movement
The results indicated reduced swelling in the knee, calf, and thigh up to 14 days after TKA in patients who received Diosmin. The reduction in swelling was associated with lower pain scores during knee movement. In contrast, pain scores at rest did not significantly differ between the Diosmin group and the control group. Assessments of knee function restoration and inflammatory biomarker levels were similar as well.
Short-term complication rates were also similar between the groups, supporting the safety of Diosmin. There was a trend toward a reduction in the frequency of postoperative nausea and vomiting with Diosmin, although the difference was not significant.
The study provides preliminary evidence that Diosmin is a safe and effective treatment for reducing swelling and pain during movement after TKA. However, it leaves questions about how Diosmin exerts this effect, especially since the results did not show a change in inflammatory biomarker levels between the groups.
„This negative result may possibly reflect the effectiveness of the other anti-inflammatory medications administered to both groups,“ write Dr. Kang and colleagues. They emphasize the need for further research to examine the mechanism through which Diosmin reduces swelling and to investigate if an alternative dosing regimen may be more effective.
Wang, Q., et al. (2021). Efficacy of Diosmin in Reducing Swelling and Pain in the Lower Extremities after Knee Arthroplasty: A Randomized, Controlled, Multicenter Study. The Journal of Bone and Joint Surgery. doi.org/10.2106/JBJS.23.00854.