Is a Combination of Diosmin and Hesperidin Effective on Swelling, Pain, and Range of Motion After Total Knee Arthroplasty?

2026-07
The Journal of arthroplasty 41(7)
- Ahmet B Girgin
- Evrim Duman

PubMed: 41161507
DOI: 10.1016/j.arth.2025.10.058

Study Design

Type: Randomized Controlled Trial (RCT)
Population: patients who underwent unilateral primary total knee arthroplasty (TKA)
Methods: randomized controlled study; diosmin and hesperidin combination vs control (no placebo) with standard postoperative treatment
Blinding: Open-label
Duration: 14 days
Funding: Unclear

Background

Swelling is one of the hindrances to functional recovery after total knee arthroplasty (TKA). The aim of this study was to investigate the effect of a diosmin and hesperidin combination on early rehabilitation of patients after TKA.

Methods

This randomized controlled study included patients who underwent unilateral primary TKA between October 2024 and June 2025. There were two groups that were determined as the diosmin and hesperidin group and the control group. The control group did not receive any placebo and only received standard postoperative treatment. The patients' extremity circumferences from the suprapatellar, patellar, and infrapatellar regions; visual analog scale scores at rest and during movement; knee joint range of motion; inflammatory markers in the blood at 24 and 48 hours, and 14 days postoperatively; and complications were compared.

Results

Flexion degrees were 78.8 on the first postoperative day, 86.7 on the second postoperative day, and 104.9 on the 14th postoperative day in the diosmin and hesperidin group, while they were 53.9, 65, and 91 degrees, respectively, in the control group (P < 0.001). Although there was a significant difference in suprapatellar and patellar circumference increases on postoperative days one and two between the two groups, there was a significant difference in suprapatellar, patellar, and infrapatellar circumference increases on day 14. There were no significant differences found between the two groups in terms of inflammatory markers.

Conclusions

Using a diosmin and hesperidin combination in the postoperative period after TKA surgery reduces extremity swelling and pain during rest and movement, increases the degree of knee flexion, and does not cause an increase in complications. Thus, it can be used to facilitate the rehabilitation of patients after TKA surgery.

Research Insights

Hesperidin→Increased Knee Flexion
Flexion degrees were 78.8 on the first postoperative day, 86.7 on the second postoperative day, and 104.9 on the 14th postoperative day in the diosmin and hesperidin group, while they were 53.9, 65, and 91 degrees, respectively, in the control group (P < 0.001).
Effect
Beneficial
Effect size
Large
Hesperidin→Reduced Extremity Swelling
Using a diosmin and hesperidin combination in the postoperative period after TKA surgery reduces extremity swelling and pain during rest and movement, increases the degree of knee flexion, and does not cause an increase in complications.
Effect
Beneficial
Effect size
Moderate
Hesperidin→Reduced Inflammatory Biomarker Level
There were no significant differences found between the two groups in terms of inflammatory markers.
Effect
Neutral
Effect size
Small
Hesperidin→Reduced Pain During Movement
Using a diosmin and hesperidin combination in the postoperative period after TKA surgery reduces extremity swelling and pain during rest and movement
Effect
Beneficial
Effect size
Moderate
Hesperidin→Reduced Pain at Rest
Using a diosmin and hesperidin combination in the postoperative period after TKA surgery reduces extremity swelling and pain during rest and movement
Effect
Beneficial
Effect size
Moderate