Abstract
Background: Bromelain, a proteolytic enzyme extracted from Ananas comosus, exhibits anti-edematous and anti-inflammatory properties that may facilitate postoperative recovery. Troxerutin and escin, respectively, a vasoactive flavonoid and a saponin derivative, also provide anti-edematous and microcirculatory benefits that could enhance tissue repair and functional outcomes. Evidence on their combined use in older adults undergoing rehabilitation after major orthopedic surgery remains limited. Methods: We conducted retrospective observational study in adults aged 65 years or older admitted to a post-acute rehabilitation unit after total hip or total knee arthroplasty. Half of the participants received an oral supplement containing bromelain (400 mg/day), troxerutin (300 mg/day), and escin (40 mg/day) for up to 21 days alongside usual care and standard medications. The primary outcome was pain reduction assessed through the Visual Analog Scale (VAS). Secondary outcomes included changes in postoperative edema and functional recovery, evaluated through range of motion, the Barthel Index, and gait performance. Result: Forty participants were enrolled (mean age 69.4 ± 7.2 years; 58 percent women). Individuals receiving the combined supplement achieved significantly greater pain improvement than controls. At day 10 (T1), VAS scores declined from 6.8 ± 1.0 to 3.2 ± 0.9 in the supplemented group versus 6.7 ± 1.1 to 4.5 ± 1.0 in controls (p < 0.01). At day 21 (T2), VAS further decreased to 1.8 ± 0.7 in the supplemented group and to 3.1 ± 0.8 with standard treatment (p < 0.001). Functional performance also improved more markedly with supplementation, with earlier mobilization and faster recovery of autonomy. No significant side effects were reported. Conclusions: In this pilot study, combined bromelain, troxerutin, and escin supplementation was associated with meaningful reductions in postoperative pain and edema and with faster functional recovery. Larger controlled trials are warranted to confirm these effects and elucidate underlying mechanisms.