Dialing in Diosmin: Promising Findings of Swelling Reduction Using Diosmin After TKA

Commentary Prior to reading this article, I was not aware of the potential benefits of diosmin. I was actually not aware of diosmin at all and had to search for more information. It appears that this synthetic flavonoid may be useful in treating a variety of conditions ranging from hemorrhoids to venous insufficiency1. On top of that, it seems to be fairly accessible and affordable. Now, on the basis of the work by Wang et al., perhaps we should consider the use of diosmin in the setting of total knee arthroplasty (TKA) to help decrease pain and swelling postoperatively. In their study, Wang et al. found diosmin to be helpful in reducing lower-extremity swelling as well as in decreasing movement-related pain after TKA. Their results come from a prospective, randomized controlled trial with 13 participating centers. The primary outcome was swelling, which was reported as a percentage based on pre- and postoperative leg circumference measurements. The authors found less swelling in the diosmin group than in the control group. There were no significant differences in adverse events between the groups. I commend the authors on this well-designed and well-executed study. However, before we start prescribing diosmin for patients undergoing knee replacements, we should consider that swelling is incredibly dynamic and multifactorial and is challenging to measure numerically. The authors controlled for as many variables as possible, and, across all sites that were measured, diosmin was associated with reduced swelling at each postoperative time point. However, it is difficult to determine a minimal clinically important difference or to quantify the amount of swelling reduction necessary to influence functional outcomes. One limitation of this particular study is the exclusion of patients with venous insufficiency, who are at the greatest risk for postoperative swelling. It is also unknown what the ideal dosage should be for patients who are in the postoperative period following TKA. In previous studies, diosmin was combined with other medications, so it may have a synergistic effect, which is yet to be studied in this population2. Promisingly, there may be other potential uses for this medication such as the unintended but positive side effect of decreased nausea demonstrated in the study by Wang et al. At this time, diosmin can be considered as another tool in the toolbox for pain and swelling after knee replacement.