Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis

Abstract

Purpose This study evaluated the clinical efficacy of continuous passive motion (CPM) following knee arthroplasty and determined the predictors of effect sizes of range of motion (ROM) and functional outcomes in patients with knee arthritis. Methods A comprehensive electronic database search was performed for randomized controlled trials (RCTs), without publication year or language restrictions. The included RCTs were analyzed through meta-analysis and risk of bias assessment. Study methodological quality (MQ) was assessed using the Physiotherapy Evidence Database (PEDro) scale. Inverse-variance weighted univariate and multivariate metaregression analyses were performed to determine the predictors of treatment outcomes. Results A total of 77 RCTs with PEDro scores ranging from 6/10 to 8/10 were included. Meta-analyses revealed an overall significant favorable effect of CPM on treatment success rates [odds ratio: 3.64, 95% confidence interval (CI) 2.21-6.00]. Significant immediate [postoperative day 14; standard mean difference (SMD): 1.06; 95% CI 0.61-1.51] and short-term (3-month follow-up; SMD: 0.80; 95% CI 0.45-1.15) effects on knee ROM and a long-term effect on function (12-month follow-up; SMD: 1.08; 95% CI 0.28-1.89) were observed. The preoperative ROM, postoperative day of CPM initiation, daily ROM increment, and total application days were significant independent predictors of CPM efficacy. Conclusion Early CPM initiation with rapid progress over a long duration of CPM application predicts higher treatment effect on knee ROM and function. The results were based on a moderate level of evidence, with good MQ and potential blinding biases in the included RCTs. An aggressive protocol of CPM has clinically relevant beneficial short-term and long-term effects on postoperative outcomes. Level of evidence II.

Effects of Elastic Resistance Exercise on Postoperative Outcomes Linked to the ICF Core Sets for Osteoarthritis after Total Knee Replacement in Overweight and Obese Older Women with Sarcopenia Risk: A Randomized Controlled Trial

“…Because the mean preoperative ROM in the CG (81.8°) was lower than that in the EG (87.4°), the results indicated that preoperative ROM may influence total ROM restoration after TKR surgery. The results of this study are supported by those of our previous study, which have indicated that preoperative ROM affects knee flexion after TKR surgery [ 56 ]. From the perspective of the ICF classification system, the EG exhibited a higher odds ratio for treatment success than the CG for mobility of joint function (code b710), which affects knee ROM.…”

Continuous Passive Motion Not Affect the Knee Motion and the Surgical wound Aspect After Total Knee Arthroplasty

“…However, some studies nd different results to ours. McInnes et al [29] or Lenssen et al [30] described an increment in active exion on the earlier postoperative days, in patients who received CPM, but not long-term bene t. Liao et al [31] obtain an improvement on ROM at 3rd and 6th month follow-up with an early application of CPM with initial high exion angle and rapid progress.…”

“…But the use of CPM in the post-TKA has remained controversial. Several studies have reported bene ts of CPM during the acute phase [10,22,31,32], while others report the absence of bene ts [11,28,33]. But we should be careful and be prudent when comparing these different studies, because there is a high degree of heterogeneity in rehabilitation protocols, with different frequency and duration of CPM applied, anesthetic and analgesic drugs used, among other.…”

Advanced rehabilitation technology in orthopaedics—a narrative review

“…Naylor et al reported that greater knee ROM at discharge after TKR was a significant predictor of improved ROM after rehabilitation [13]. A recent meta-analysis provided statistically significant, moderate evidence, indicating that CPM reduced pain, restored knee ROM and enhanced functional recovery after TKR regardless of follow-up duration [14]. It has been suggested that CPM leads to positive biological effects on tissue healing, oedema and haemarthrosis [11,15].…”