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Randomized Controlled Trial
. 2008 Apr 29:9:60.
doi: 10.1186/1471-2474-9-60.

Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty

Ton A F Lenssen  1 , Mike J A van Steyn, Yvonne H F Crijns, Eddie M H Waltjé, George M Roox, Ruud J T Geesink, Piet A van den Brandt, Rob A De Bie
Affiliations
Randomized Controlled Trial

Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty

Ton A F Lenssen et al. BMC Musculoskelet Disord. .

Abstract

Background: Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered.

Methods: In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee.

Results: Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments.

Conclusion: Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected.

Trial registration: ISRCTN85759656.

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Figures

Figure 1
Figure 1
Study design and outcome assessment. T0 baseline assessment, one week before surgery, T1 assessment 4 days after surgery, T2 assessment 17 days after surgery, T3 assessment 6 weeks after surgery T4 assessment 3 months after surgery, R = randomisation.
Figure 2
Figure 2
Flowchart of subjects through the trial.
Figure 3
Figure 3
Progress of active RoM through the trial period.
See this image and copyright information in PMC

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