Is there different sizes

It is a one size fits all. It has ample length , i would say it fits up to an X-tra large. I’m a heavy heavy guy, and it fits just fine. Take a chance at relief, you can always return it, but I doubt you will. Really a terrific item, I love mine .👍

Can these be put into the microwave to heat

The removable inserts are called arctic flex so I assume they are just for freezing. It doesn’t say anything about not microwaving but I wouldn’t recommend it or ...do it at your own risk.

Is this the same as a ice bath?

No. With an ice bath, you'd stick your leg, body, or whatever into a tub of ice water. This device simply applies and compresses cold gel backs around your knee. It works okay, but I prefer other ways of cooling the knee, e.g., a large FlexiKold pack strapped to your leg.

Are there extra gel packs available for purchase for this item?

There are. They come in sets of 3. I ordered the extra set and it was a good move. My son's rehab doctor had him ice 20 minutes, remove 20 minutes, and then ice again another 20 minutes. Having that second set guaranteed that he had ice packs for both icing sessions in the hour.

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❄️🎈 Elevate your knee care game with customizable cold & compression relief!

RISK FREE RECOVERY - Backed by a 60-day Vive guarantee for confident, worry-free healing.
TARGETED PAIN RELIEF - Combines cold/heat therapy with compression to reduce inflammation, swelling, and stiffness.
UNIVERSAL FIT COMFORT - Latex-free neoprene blend with four adjustable straps fits either knee up to 21" circumference.
FLEXIBLE HOT COLD THERAPY - Three removable gel packs contour perfectly, staying flexible even when frozen.
PERSONALIZED COMPRESSION CONTROL - Hand pump lets you dial in the perfect pressure for your knee’s unique needs.

The Vive Compression Knee Ice Wrap offers professional-grade pain management by combining adjustable air compression with flexible hot or cold therapy. Featuring three reusable Arctic Flex gel packs and a latex-free neoprene design, it fits either knee comfortably and supports recovery from injuries, arthritis, and surgery with a 60-day satisfaction guarantee.

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