The Role of Continuous Passive Motion Following Total Knee Arthroplasty

Dw, Romness; Ja, Rand

doi:10.1097/00003086-198801000-00007

Cited by 61 publications

(26 citation statements)

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“…[7][8][9] This accelerated return of flexion may reduce the need for manipulation. 7,10 To minimise the risk of hypoxia of the wound edge and subsequent infection, Johnson 11 and Goletz and Henry 12 recommend limiting CPM to less than 40° in the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Manipulation of total knee replacements

Esler

Lock

Harper

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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A s part of a prospective study of 476 total knee replacements (TKR), we evaluated the use of manipulation under anaesthesia in 47 knees. Manipulation was considered when intensive physiotherapy failed to increase flexion to more than 80°. The mean time from arthroplasty to manipulation was 11.3 weeks (median 9, range 2 to 41). The mean active flexion before manipulation was 62° (35 to 80). One year later the mean gain was 33° (Wilcoxon signed-rank test, range -5 to 70, 95% CI 28.5 to 38.5). Definite sustained gains in flexion were achieved even when manipulation was performed four or more months after arthroplasty (paired t-test, p < 0.01, CI 8.4 to 31.4).A further 21 patients who met our criteria for manipulation declined the procedure. Despite continued physiotherapy, there was no significant increase in flexion in their knees. Six weeks to one year after TKR, the mean change was 3.1° (paired t-test, p = 0.23, CI -8.1 to +2). [Br] 1999;81-B:27-9. Received 23 February 1998; Accepted after revision 16 June 1998 While the primary aims of total knee arthroplasty are relief of pain and restoration of mobility, an adequate range of movement (ROM) is also desirable. Laubenthal, Smidt and Kettelkamp 1 assessed the amount of flexion necessary for everyday activities and found that the mean flexion required to climb stairs, to sit, and to tie a shoelace was 83°, 93° and 106°, respectively. The ROM attained after total knee replacement (TKR) depends not only on such factors as prosthetic design and soft-tissue balance, but also on patient morphology, the preoperative ROM and motivation. J Bone Joint Surg2-4 Some patients may be satisfied with less flexion as long as they have relief from pain. The long-term benefits of manipulation under anaesthesia (MUA) after TKR have been questioned. 5 The known complications of manipulation, including supracondylar fracture, avulsion of the patellar tendon, myositis ossificans and wound breakdown, may further compromise poor results. These occur, however, in fewer than 3% of patients. 6 Our aim was to evaluate the use of MUA in patients whose maximum flexion was less than 80° despite intensive physiotherapy.

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Section: Discussionmentioning

confidence: 99%

Manipulation of total knee replacements

Esler

Lock

Harper

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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“…Previous studies suggest using CPM in a limited motion arc is less effective in clearing blood and edema from the joint [18,19] and is unlikely to provide any impact on long-term ROM achieved by the patient after TKA [4,11,22,30,31]. Similarly, it has been suggested improved postoperative ROM might be seen if greater CPM motion arcs were used, because the periarticular tissues would experience an increased pumping effect, reducing hemarthrosis and stasis of inflammatory mediators helping to maintain long-term periarticular tissue compliance [17].…”

Section: Discussionmentioning

confidence: 99%

“…For more than 25 years, the CPM machine has been used to facilitate rehabilitation after TKA and other joint reconstructions [1,11,21,22,25,27,31]. The concept of CPM, initially introduced by Salter et al [25][26][27][28], was based on findings that immobilization of a joint after surgery gave rise to detrimental effects on articular collagen healing.…”

Section: Introductionmentioning

confidence: 99%

“…In a meta-analysis of 952 patients, Brosseau et al [2] reported the length of hospital stay was shorter in patients who received postoperative CPM. Furthermore, the addition of this modality to physical therapy also reduced the number of patients requiring postoperative knee manipulations [2,7,12,22,30,31].…”

Section: Introductionmentioning

confidence: 99%

“…Studies showing the superiority of CPM over physical therapy alone used regimens with larger motion arcs (eg, 70°-90°) continued for a longer duration of time (eg, [ 48 h) [9,17,20]. Conversely, clinical investigations that failed to record an increase in knee ROM in conjunction with CPM used more limited motion arcs, which typically were started between 30°and 40°and increased by 10°to 20°each day [4,11,22,30,31]. In a direct comparison of these various CPM protocols, implementation of higher motion arcs brought about greater ROM, which remained evident 1 year after surgery [9].…”

Section: Introductionmentioning

confidence: 99%

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Actual Knee Motion during Continuous Passive Motion Protocols is Less Than Expected

Bible¹,

Simpson²,

Biswas³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Investigations of the usefulness of continuous passive motion (CPM) after TKA have yielded mixed results, with evidence suggesting its efficacy is contingent on the presence of larger motion arcs. Surprisingly, the range of motion (ROM) the knee actually experiences while in a CPM machine has not been elucidated. In this study, the ability of a CPM apparatus to bring about a desired knee ROM was assessed with an electrogoniometer. The knee experienced only 68% to 76% of the programmed CPM arc, with the higher percentages generated by elevating the head of the patient's bed. This disparity between true knee motion and CPM should be accounted for when designing CPM protocols for patients or investigations evaluating efficacy of CPM.

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