Continuous passive motion following total knee replacement: a prospective randomized trial with follow-up to 1 year

Abstract

We have carried out a prospective randomised, single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion, lack of extension, pain levels and analgesic use after total knee replacement surgery. 85 subjects were randomly allocated to control or study group. All subjects followed the existing rehabilitation protocol, which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h, twice a day. Outcome measures employed were range of motion, pain assessed on a visual analogue scale and analgesic use according to the WHO ladder. Blinded evaluation was carried out preoperatively, at time of discharge from hospital, 6 weeks, 6 and 12 months postoperation. No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests. The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain.

Common controversies in total knee replacement surgery: Current evidence

“…However, the authors also highlighted the need for further research about the use of CPM, because of its inconvenience and expense, and put the question about the determination of protocols concerning the duration and intensity of CPM application [28] . Following this study, Leach et al [29] in 2006 published a prospective randomized trial, with a 1-year follow-up, in which they concluded that CPM does not offer significant benefits in range of knee motion and pain, after the application of a specific CPM protocol. This publication initiated a series of highquality studies, which, since then, have contested the use of CPM after TKA.…”

“…CPM use or not for computer-assisted TKA No statistically significant difference in flexion, edema or drainage, function, or pain between groups 3 mo post-surgery Lensenn et al [31] Randomised controlled trial. Effectiveness of prolonged CPM use vs in hospital only use of CPM No long term difference in ROM or any of the outcome assessments Leach et al [29] Prospective randomized trial investigating the effect of CPM on range of knee flexion, lack of extension, pain levels and analgesic use after TKR…”

Recuperación de la artroplastia de rodilla a través de la movilización pasiva continua

“…• GC (19): recibió fisioterapia convencional más CPM. 30 minutos/día desde postoperatorio durante 3 semanas.…”

“…Siendo la mayor muestra, N= 170, del trabajo realizado por Chen y col 14 y la menor muestra, N=38, la utilizada en la investigación de Mau-Moeller A. y col 15 . En todos los trabajos analizados se tomaron medidas en cuanto al rango de movilidad articular, tanto en flexión como extensión [14][15][16][17][18][19][20][21][22][23][24][25] . El dolor fue el segundo parámetro más estudiado, siendo valorado en todos los trabajos excepto en los realizados por Lenssen y col 16 , Herbold y col 17 y Davies y col 18 .…”

“…En cada estudio se añadieron además otras medidas secundarias como el uso de analgésicos 19 16 , satisfacción con el tratamiento y su resultado 16 , adhesión de los protocolos de tratamiento y uso de la movilización pasiva continua 16 , y la cantidad, duración y naturaleza de la intervención de fisioterapia 16 . En todos los estudios [14][15][16][17][18][19][20][21][22][23][24][25] se realizó la medida de los parámetros analizados antes de que los pacientes fueran sometidos a la artroplastia, es en la temporalización del resto de valoraciones donde más difieren unos de otros. Los trabajos realizados por Leach y col 19 y por Denis y col 22 coinciden en realizar una nueva valoración de los parámetro de estudio en el momento del alta hospitalaria.…”