Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Feb 6;2014(2):CD004260.
doi: 10.1002/14651858.CD004260.pub3.

Continuous passive motion following total knee arthroplasty in people with arthritis

Lisa A Harvey  1 , Lucie Brosseau, Robert D Herbert
Affiliations
Meta-Analysis

Continuous passive motion following total knee arthroplasty in people with arthritis

Lisa A Harvey et al. Cochrane Database Syst Rev. .

Abstract

Background: Arthritis of the knee is a common problem causing pain and disability. If severe, knee arthritis can be surgically managed with a total knee arthroplasty. Rehabilitation following knee arthroplasty often includes continuous passive motion (CPM). CPM is applied by a machine that passively and repeatedly moves the knee through a specified range of motion (ROM). It is believed that CPM increases recovery of knee ROM and has other therapeutic benefits. However, it is not clear whether CPM is effective.

Objectives: To assess the benefits and harms of CPM and standard postoperative care versus similar postoperative care, with or without additional knee exercises, in people with knee arthroplasty. This review is an update of a 2003 and 2010 version of the same review.

Search methods: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (January 1966 to 24 January 2013), EMBASE (January 1980 to 24 January 2013), CINAHL (January 1982 to 24 January 2013), AMED (January 1985 to 24 January 2013) and PEDro (to 24 January 2013).

Selection criteria: Randomised controlled trials in which the experimental group received CPM, and both the experimental and control groups received similar postoperative care and therapy following total knee arthroplasty in people with arthritis.

Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. The primary outcomes of interest were active knee flexion ROM, pain, quality of life, function, participants' global assessment of treatment effectiveness, incidence of manipulation under anaesthesia and adverse events. The secondary outcomes were passive knee flexion ROM, active knee extension ROM, passive knee extension ROM, length of hospital stay, swelling and quadriceps strength. We estimated effects for continuous data as mean differences or standardised mean differences (SMD), and effects for dichotomous data as risk ratios; all with 95% confidence intervals (CI). If appropriate, we performed meta-analyses using random-effects models.

Main results: We identified 684 papers from the electronic searches after removal of duplicates and retrieved the full reports of 62 potentially eligible trials. Twenty-four randomised controlled trials of 1445 participants met the inclusion criteria; four of these trials were new to this update.There was moderate-quality evidence to indicate that CPM does not have clinically important short-term effects on active knee flexion ROM: mean knee flexion was 78 degrees in the control group, CPM increased active knee flexion ROM by 2 degrees (95% CI 0 to 5) or absolute improvement of 2% (95% CI 0% to 4%). The medium- and long-term effects are similar although the quality of evidence is lower.There was low-quality evidence to indicate that CPM does not have clinically important short-term effects on pain: mean pain was 3 points in the control group, CPM reduced pain by 0.4 points on a 10-point scale (95% CI -0.8 to 0.1) or absolute reduction of -4% (95% CI -8% to 1%).There was moderate-quality evidence to indicate that CPM does not have clinically important medium-term effects on function: mean function in the control group was 56 points, CPM decreased function by 1.6 points (95% CI -6.1 to 2.0) on a 100-point scale or absolute reduction of -2% (95% CI -5% to 2%). The SMD was -0.1 standard deviations (SD) (95% CI -0.3 to 0.1).There was moderate-quality evidence to indicate that CPM does not have clinically important medium-term effects on quality of life: mean quality of life was 40 points in the control group, CPM improved quality of life by 1 point on a 100-point scale (95% CI -3 to 4) or absolute improvement of 1% (95% CI -3% to 4%).There was very low-quality evidence to indicate that CPM reduces the risk of manipulation under anaesthesia; risk of manipulation in the control group was 7.2%, risk of manipulation in the experimental group was 1.6%, CPM decreased the risk of manipulation by 25 fewer manipulations per 1000 (95% CI 9 to 64) or absolute risk reduction of -4% (95% CI -8% to 0%). The risk ratio was 0.3 (95% CI 0.1 to 0.9).There was low-quality evidence to indicate that CPM reduces the risk of adverse events; risk of adverse events in the control group was 16.3%, risk of adverse events in the experimental group was 17.9%, CPM decreased the risk of adverse event by 150 fewer adverse events per 1000 (95% CI 103 to 216) or absolute risk reduction of -1% (95% CI -5% to 3%). The risk ratio was 0.9 (95% CI 0.6 to 1.3). The estimates for risk of manipulation and adverse events are very imprecise and the estimate for the risk of adverse events does not distinguish between a clinically important increase and decrease in risk.There was insufficient evidence to determine the effect of CPM on participants' global assessment of treatment effectiveness.

Authors' conclusions: CPM does not have clinically important effects on active knee flexion ROM, pain, function or quality of life to justify its routine use. It may reduce the risk of manipulation under anaesthesia and risk of developing adverse events although the quality of evidence supporting these findings are very low and low, respectively. The effects of CPM on other outcomes are unclear.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram. Results from the 2003 version of this systematic review are included in the 2009 search results because a full search was re‐done in 2009 using a new search strategy.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included trial.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Main comparison, Outcome 1 Active knee flexion ROM ‐ short‐term effects.
1.2
1.2. Analysis
Comparison 1 Main comparison, Outcome 2 Active knee flexion ROM ‐ medium‐term effects.
1.3
1.3. Analysis
Comparison 1 Main comparison, Outcome 3 Active knee flexion ROM ‐ long‐term effects.
1.4
1.4. Analysis
Comparison 1 Main comparison, Outcome 4 Pain ‐ short‐term effects.
1.5
1.5. Analysis
Comparison 1 Main comparison, Outcome 5 Pain ‐ medium‐term effects.
1.6
1.6. Analysis
Comparison 1 Main comparison, Outcome 6 Pain ‐ long‐term effects.
1.7
1.7. Analysis
Comparison 1 Main comparison, Outcome 7 Function ‐ short‐term effects [standardised mean].
1.8
1.8. Analysis
Comparison 1 Main comparison, Outcome 8 Function ‐ medium‐term effects [standardised mean].
1.9
1.9. Analysis
Comparison 1 Main comparison, Outcome 9 Function ‐ long‐term effects [standardised mean].
1.10
1.10. Analysis
Comparison 1 Main comparison, Outcome 10 Quality of life ‐ medium‐term effects.
1.11
1.11. Analysis
Comparison 1 Main comparison, Outcome 11 Quality of life ‐ long‐term effects.
1.12
1.12. Analysis
Comparison 1 Main comparison, Outcome 12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points].
1.13
1.13. Analysis
Comparison 1 Main comparison, Outcome 13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects.
1.14
1.14. Analysis
Comparison 1 Main comparison, Outcome 14 Manipulation under anaesthesia [number].
1.15
1.15. Analysis
Comparison 1 Main comparison, Outcome 15 Adverse events [number].
1.16
1.16. Analysis
Comparison 1 Main comparison, Outcome 16 Passive knee flexion ROM ‐ short‐term effects.
1.17
1.17. Analysis
Comparison 1 Main comparison, Outcome 17 Passive knee flexion ROM ‐ medium‐term effects.
1.18
1.18. Analysis
Comparison 1 Main comparison, Outcome 18 Passive knee flexion ROM ‐ long‐term effects.
1.19
1.19. Analysis
Comparison 1 Main comparison, Outcome 19 Active knee extension ROM ‐ short‐term effects.
1.20
1.20. Analysis
Comparison 1 Main comparison, Outcome 20 Active knee extension ROM ‐ medium‐term effects.
1.21
1.21. Analysis
Comparison 1 Main comparison, Outcome 21 Active knee extension ROM ‐ long‐term effects.
1.22
1.22. Analysis
Comparison 1 Main comparison, Outcome 22 Passive knee extension ROM ‐ short‐term effects.
1.23
1.23. Analysis
Comparison 1 Main comparison, Outcome 23 Passive knee extension ROM ‐ medium‐term effects.
1.24
1.24. Analysis
Comparison 1 Main comparison, Outcome 24 Passive knee extension ROM ‐ long‐term effects.
1.25
1.25. Analysis
Comparison 1 Main comparison, Outcome 25 Length of hospital stay.
1.26
1.26. Analysis
Comparison 1 Main comparison, Outcome 26 Swelling ‐ short‐term effects.
1.27
1.27. Analysis
Comparison 1 Main comparison, Outcome 27 Swelling ‐ medium‐term effects.
1.28
1.28. Analysis
Comparison 1 Main comparison, Outcome 28 Quadriceps strength ‐ short‐term effects [standardised mean].
2.1
2.1. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 1 Active knee flexion ROM.
2.2
2.2. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 2 Passive knee flexion ROM.
2.3
2.3. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 3 Active knee extension ROM.
2.4
2.4. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 4 Passive knee extension ROM.
2.5
2.5. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 5 Length of hospital stay.
2.6
2.6. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 6 Function.
2.7
2.7. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 7 Pain.
2.8
2.8. Analysis
Comparison 2 Secondary comparison ‐ subgroup of studies in which control participants received additional knee exercises, Outcome 8 Swelling.
3.1
3.1. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 1 Active knee flexion ROM ‐ short‐term effects.
3.2
3.2. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 2 Active knee flexion ROM ‐ medium‐term effects.
3.3
3.3. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 3 Active knee flexion ROM ‐ long‐term effects.
3.4
3.4. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 4 Pain ‐ short‐term effects.
3.5
3.5. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 5 Pain ‐ medium‐term effects.
3.6
3.6. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 6 Pain ‐ long‐term effects.
3.7
3.7. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 7 Function ‐ short‐term effects [standardised mean].
3.8
3.8. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 8 Function ‐ medium‐term effects [standardised mean].
3.9
3.9. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 9 Function ‐ long‐term effects [standardised mean].
3.10
3.10. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 10 Quality of life ‐ medium‐term effects.
3.11
3.11. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 11 Quality of life ‐ long‐term effects [points].
3.12
3.12. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 12 Participants' global assessment of treatment effectiveness ‐ short‐term effects [points].
3.13
3.13. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 13 Participants' global assessment of treatment effectiveness ‐ medium‐term effects.
3.14
3.14. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 14 Manipulation under anaesthesia [number].
3.15
3.15. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 15 Adverse events [number].
3.16
3.16. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 16 Passive knee flexion ROM ‐ short‐term effects.
3.17
3.17. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 17 Passive knee flexion ROM ‐ medium‐term effects.
3.18
3.18. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 18 Passive knee flexion ROM ‐ long‐term effects.
3.19
3.19. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 19 Active knee extension ROM ‐ short‐term effects.
3.20
3.20. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 20 Active knee extension ROM ‐ medium‐term effects.
3.21
3.21. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 21 Active knee extension ROM ‐ long‐term effects.
3.22
3.22. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 22 Passive knee extension ROM ‐ short‐term effects.
3.23
3.23. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 23 Passive knee extension ROM ‐ medium‐term effects.
3.24
3.24. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 24 Passive knee extension ROM ‐ long‐term effects.
3.25
3.25. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 25 Quadriceps strength ‐ short‐term effects [standardised mean].
3.26
3.26. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 26 Length of hospital stay.
3.27
3.27. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 27 Swelling ‐ short‐term effects.
3.28
3.28. Analysis
Comparison 3 Main comparison ‐ sensitivity analysis using fixed‐effect model, Outcome 28 Swelling ‐ medium‐term effects.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Alkire 2010 {published data only}
    1. Alkire MR, Swank M. Use of inpatient continuous passive motion versus no CPM in computer‐assisted total knee arthroplasty. Orthopaedic Nursing 2010;29:36‐40. - PubMed
Bennett 2005 {published data only}
    1. Bennett LA, Brearley SC, Hart JA, Bailey MJ. A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. Journal of Arthroplasty 2005;20:225‐33. - PubMed
Bruun‐Olsen 2009 {published data only}
    1. Bruun‐Olsen V, Heiberg KE, Mengshoel AM. Continuous passive motion as an adjunct to active exercises in early rehabilitation following total knee arthroplasty ‐ a randomized controlled trial. Disability & Rehabilitation 2009;31:277‐83. - PubMed
Can 1995 {published data only}
    1. Can F, Algun C, Alpaslan M. Effect of the CPM in total knee arthroplasty. Physiotherapy 1995;81:453.
Chiarello 1997 {published data only}
    1. Chiarello CM, Gundersen MS, O'Halloran T. The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. Journal of Orthopaedic and Sports Physical Therapy 1997;25(2):119‐27. - PubMed
Colwell 1992 {published data only}
    1. Colwell CW, Morris BA. The influence of continuous passive motion on the results of total knee arthroplasty. Clinical Orthopaedics and Related Research 1992;276:225‐8. - PubMed
Denis 2006 {published data only}
    1. Denis M, Moffet H, Caron F, Ouellet D, Paquet J, Nolet L. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Physical Therapy 2006;86:174‐85. - PubMed
Harms 1991 {published data only}
    1. Harms M, Engstrom B. Continuous passive motion as an adjunct to treatment in the physiotherapy management of the total knee arthroplasty patient. Physiotherapy 1991;7(4):301‐7.
Huang 2003 {published data only}
    1. Huang D, Peng Y, Su P, Ye W, Liang A. The effect of continuous passive motion after total knee arthroplasty on joint function. Chinese Journal of Clinical Rehabilitation 2003;7:1661‐2.
Kumar 1996 {published data only}
    1. Kumar PJ, McPherson EJ, Dorr LD, Wan Z, Baldwin K. Rehabilitation after total knee arthroplasty: a comparison of two rehabilitation techniques. Clinical Orthopaedics and Related Research 1996;331:93‐101. - PubMed
Lau 2001 {published data only}
    1. Lau SKK, Chiu KY. Use of continuous passive motion after total knee arthroplasty. Journal of Arthroplasty 2001;16(3):336‐9. - PubMed
Lenssen 2003a {published data only}
    1. Lenssen A, Bie RA, Bulstra SK, Steyn MJA. Continuous passive motion (CPM) in rehabilitation following total knee arthroplasty: a randomised controlled trial. Physical Therapy Review 2003;8:123‐9.
Lenssen 2008 {published data only}
    1. Lenssen TA, Steyn MJ, Crijns YH, Waltje EM, Roox GM, Geesink RJ, et al. Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskeletal Disorders 2008;9:60. - PMC - PubMed
MacDonald 2000 {published data only}
    1. MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW, Kramer J, Vaz M. Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty. Clinical Orthopaedics and Related Research 2000;380:30‐5. - PubMed
Maniar 2012 {published data only}
    1. Maniar RN, Baviskar JV, Singhi T, Rathi SS. To use or not to use continuous passive motion post‐total knee arthroplasty presenting functional assessment results in early recovery. Journal of Arthroplasty 2012;27:193‐200. - PubMed
May 1999 {published data only}
    1. May A, Busse W, Zayac D, Withridge M. Comparison of continuous passive motion (CPM) machines and lower limb mobility boards (LLiMB) in the rehabilitation of patients with total knee arthroplasty. Canadian Journal of Rehabilitation 1999;12:257‐63.
McInnes 1992 {published data only}
    1. McInnes J, Larson MG, Daltroy LH, Brown T, Fossel AH, Eaton HM, et al. A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. JAMA 1992;268(11):1423‐8. - PubMed
Montgomery 1996 {published data only}
    1. Montgomery F, Eliasson M. Continuous passive motion compared to active physical therapy after total knee arthroplasty: similar hospitalization times in a randomized study of 68 patients. Acta Orthopaedica Scandinavica 1996;67(1):7‐9. - PubMed
Ng 1999 {published data only}
    1. Ng TS, Yeo SJ. An alternative early knee flexion regimen of continuous passive motion for total knee arthroplasty. Physiotherapy Singapore 1999;2:53‐63.
Nielsen 1988 {published data only}
    1. Nielsen PT, Rechnagel K, Nielsen SE. No effect of continuous passive motion after total knee arthroplasty of the knee. Acta Orthopaedica Scandinavica 1988;59(5):580‐1. - PubMed
Ritter 1989 {published data only}
    1. Ritter MA, Gandolf VS, Holston KS. Continuous passive motion versus physical therapy in total knee arthroplasty. Clinical Orthopaedics and Related Research 1989;244:239‐43. - PubMed
Sahin 2006 {published data only}
    1. Sahin E, Akalin E, Bircan C, Karaoglan O, Tatari H, Alper S, et al. The effects of continuous passive motion on outcome in total knee arthroplasty. Journal of Rheumatology and Medical Rehabilitation 2006;17:85‐90.
Vince 1987 {published data only}
    1. Vince K, Kelly M, Beck J, Insall J. Continuous passive motion after total knee arthroplasty. Journal of Arthroplasty 1987;2:281‐4. - PubMed
Worland 1998 {published data only}
    1. Worland RL, Arredondo J, Angles F, Jimenez FL, Jessup DE. Home continuous passive motion machine versus professional physical therapy following total knee replacement. Journal of Arthroplasty 1998;13(7):784‐7. - PubMed

References to studies excluded from this review

Beaupré 2001 {published data only}
    1. Beaupré LA, Davies DM, Jones CA, Cinats JG. Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Physical Therapy 2001;81(4):1029‐37. - PubMed
Chen 2000 {published data only}
    1. Chen B, Zimmerman JR, Soulen L, DeLisa JA. Continuous passive motion after total knee arthroplasty: a prospective study. American Journal of Physical Medicine and Rehabilitation 2000;79(5):421‐6. - PubMed
Coutts 1983 {published data only}
    1. Coutts R, Borden L, Bryan R, Hungerford D, Stulberg B, Stulberg S. The effect of continuous passive motion on total knee rehabilitation. Orthopaedic Transactions 1983;3:535‐6.
Davis 1984 {published data only}
    1. Davis D. Continuous passive motion for total knee arthroplasty. Physical Therapy 1984;64:709.
Haug 1988 {published data only}
    1. Haug J, Wood LT. Efficacy of neuromuscular stimulation of the quadriceps femoris during continuous passive motion following total knee arthroplasty. Archives of Physical Medicine and Rehabilitation 1988;69:423‐4. - PubMed
Johnson 1990 {published data only}
    1. Johnson DP. The effect of continuous passive motion on wound‐healing and joint mobility after knee arthroplasty. Journal of Bone and Joint Surgery 1990;72‐A(3):421‐6. - PubMed
Johnson 1992 {published data only}
    1. Johnson DP. Beneficial effects of continuous passive motion after total condylar knee arthroplasty. Annals of the Royal College of Surgeons of England 1992;74:412‐6. - PMC - PubMed
Kim 1995 {published data only}
    1. Kim J‐M, Moon M‐S. Squatting following total knee arthroplasty. Clinical Orthopaedics and Related Research 1995;313:177‐86. - PubMed
Kim 2009 {published data only}
    1. Kim TK, Park KK, Yoon SW, Kim SJ, Chang CB, Seong SC. Clinical value of regular passive ROM exercise by a physical therapist after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2009;17:1152‐8. - PubMed
Leach 2006 {published data only}
    1. Leach W, Reid J, Murphy F. Continuous passive motion following total knee replacement: a prospective randomized trial with follow‐up to 1 year. Knee Surgery, Sports Traumatology, Arthroscopy 2006;14:922‐6. - PubMed
Leonard 2007 {published data only}
    1. Leonard GM, Tremblay LE, Chabot M, Lariviere J, Papadopoulos P. The effects of early continuous passive motion after total knee arthroplasty. Physiotherapy Canada 2007;59:111‐7.
Lynch 1988 {published data only}
    1. Lynch AF, Bourne RB, Rorabeck CH, Rankin RN, Donald A. Deep‐vein thrombosis and continuous passive motion after total knee arthroplasty. Journal of Bone and Joint Surgery 1988;70‐A(1):11‐4. - PubMed
Maloney 1990 {published data only}
    1. Maloney WJ, Schurmann DJ, Hangen D, Goodman SB, Edworthy S, Bloch DA. The influence of continuous passive motion on outcome in total knee arthroplasty. Clinical Orthopaedics and Related Research 1990;256:162‐8. - PubMed
Odenbring 1989 {published data only}
    1. Odenbring S, Lindstrand A, Egund N. Early knee mobilization after osteotomy for gonarthrosis. Acta Orthopaedica Scandinavica 1989;60(6):699‐702. - PubMed
Pope 1997 {published data only}
    1. Pope RO, Corcoran S, McCaul K, Howie DW. Continuous passive motion after primary total knee arthroplasty: does it offer any benefits?. Journal of Bone and Joint Surgery 1997;79‐B(6):914‐7. - PubMed
Simkin 1999 {published data only}
    1. Simkin PA, Lateur BJ, Alquist AD, Wuestad KA, Beardsley RM, Esselman PC. Continuous passive motion for osteoarthritis of the hip: a pilot study. Journal of Rheumatology 1999;26:1987‐91. - PubMed
Ververeli 1995 {published data only}
    1. Ververeli PA, Sutton DC, Hearn SL, Booth RE, Hozack WJ, Rothman RR. Continuous passive motion after total knee arthroplasty. Analysis of costs and benefits. Clinical Orthopaedics and Related Research 1995;321:208‐15. - PubMed
Walker 1991 {published data only}
    1. Walker RH, Morris BA, Angulo DL, Schneider J, Colwell CW. Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty [Phase 1]. Journal of Arthroplasty 1991;6(2):151‐6. - PubMed
Woog 2008 {published data only}
    1. Woog L, Vandeput C. Usefulness of continuous passive mobilization early after total knee arthroplasty: comparison of two rehabilitation protocols [Interet de l'utilisation precoce de la mobilisation passive continue apres une prothese totale de genou. Comparaison de deux protocoles de reeducation]. Kinesitherapie Revue 2008;77:38‐43.
Yashar 1997 {published data only}
    1. Yashar AA, Venn‐Watson E, Welsh T, Colwell CW, Lotke P. Continuous passive motion with accelerated flexion after total knee arthroplasty. Clinical Orthopaedics and Related Research 1997;345:38‐43. - PubMed
Young 1984 {published data only}
    1. Young JS, Kroll MA. Continuous passive motion compared to active assisted range of motion. Physical Therapy 1984;64:721.

References to studies awaiting assessment

Aubriot 1993 {published data only}
    1. Aubriot JH, Guincestre JY, Grandbastien B. Rehabilitation following total knee arthroplasty. Role of passive motion. A randomised study about 120 subjects [Intérêt des appareils arthromoteurs dans la rééducation précoce des arthroplasties totales de genou. Étude prospective à propos de 120 dossiers]. Revue de Chirurgie Orthopédique 1993;79:586‐90. - PubMed
Cui 2009 {published data only}
    1. Cui XQ, Wang HZ, Li W. Influence of time for continuous passive activities on range of motion following total knee arthroplasty. Journal of Clinical Rehabilitative Tissue Engineering Research 2009;13:4237‐40.
Ersozlu 2009 {published data only}
    1. Ersozlu S, Sahin O, Ozgur AF, Tuncay IC. The effects of two different continuous passive motion protocols on knee range of motion after total knee arthroplasty: a prospective analysis [Iki farkli surekli pasif hareket protokolunun total diz protezi sonrasi diz hareket acikligina etkileri: Ileriye donuk bir calisma]. Acta Orthopaedica et Traumatologica Turcica 2009;43:412‐8. - PubMed
Li 2010 {published data only}
    1. Li XL. Velocity factor of continuous passive motion following knee replacement: differences between treatment and control groups. Journal of Clinical Rehabilitative Tissue Engineering Research 2010;14:2349‐52.
Li 2010a {published data only}
    1. Li XL, Zhao XO. Continuous passive joint motion following total knee replacement: 48 cases analysis. Journal of Clinical Rehabilitative Tissue Engineering Research 2010;14:665‐8.
Liu 2011 {published data only}
    1. Liu W, Wu YL, Cong RJ, Fu PL, Li XH, Wu HS. Controlled active motion and continuous passive motion are beneficial to function rehabilitation after total knee arthroplasty. Journal of Clinical Rehabilitative Tissue Engineering Research 2011;15:6509‐13.
Sosin 2000 {published data only}
    1. Sosin P, Dutka J, Stabach M. A comparison of kinesitherapy with and without continuous passive motion (CPM) after the entire allograft surgery of the knee. Chirurgia Narzadow Ruchu I Ortopedia Polska 2000;65:47‐53. - PubMed

Additional references

Cates 2008 [Computer program]
    1. Cates C. Visual Rx 2.0 NNT Calculator. www.nntonline.net. Dr Chris Cates' EBM website, 2000.
Dickersin 1993
    1. Dickersin K, Min YI. NIH clinical trials and publication bias. The Online Journal of Current Clinical Trials 1993;April 28:Doc No 50. - PubMed
Du Plessis 2011
    1. Du Plessis M, Eksteen E, Jenneker A, Kriel E, Mentoor C, Stucky T, et al. The effectiveness of continuous passive motion on range of motion, pain and muscle strength following rotator cuff repair: a systematic review. Clinical Rehabilitation 2011;25:291‐302. - PubMed
Egger 1998
    1. Egger M, Smith GD. Meta‐analysis. Bias in location and selection of studies. BMJ 1998;316:61‐6. - PMC - PubMed
Fazalare 2010
    1. Fazalare JA, Griesser MJ, Siston RA, Flanigan DC. The use of continuous passive motion following knee cartilage defect surgery: a systematic review. Orthopedics (Online) 2010;33:878. - PubMed
Fisher 1985
    1. Fisher RL, Kloter K, Bzdyra B, Cooper JA. Continuous passive motion (C.P.M.) following total knee replacement. Connecticut Medicine 1985;49:498‐501. - PubMed
Fox 1981
    1. Fox JL, Poss R. The role of manipulation following total knee replacement. Journal of Bone and Joint Surgery 1981;63‐A(3):357‐62. - PubMed
Gluud 2006
    1. Gluud LL. Bias in clinical intervention research. American Journal of Epidemiology 2006;163:493‐501. - PubMed
Grella 2008
    1. Grella, RJ. Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation?. Physical Therapy Reviews 2008;13:269‐79.
Hemmerich 2006
    1. Hemmerich A, Brown H, Smith S, Marthandam SS, Wyss UP. Hip, knee, and ankle kinematics of high range of motion activities of daily living. Journal of Orthopaedic Research 2006;24(4):770‐81. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lenssen 2003b
    1. Lenssen AF, Koke AJ, Ade Bie RA, Geesink RGT. Continuous passive motion following primary total knee arthroplasty: short‐ and long‐term effects on range of motion. Physical Therapy Reviews 2003;8:113‐21.
Lobb 2012
    1. Lobb R, Tumilty S, Claydon LS. A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation. Physical Therapy in Sport 2012;13:270‐8. - PubMed
McCarthy 1992
    1. McCarthy MR, O'Donoghue PC, Yates CK, Yates‐McCarthy JL. The clinical use of continuous passive motion in physical therapy. Journal of Orthopaedic and Sports Physical Therapy 1992;15(3):132‐40. - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Rowe 2000
    1. Rowe PJ, Myles CM, Walker C, Nutton R. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?. Gait and Posture 2000;12(2):143‐55. - PubMed
Salter 1989
    1. Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clinical Orthopaedics and Related Research 1989;May(242):12‐25. - PubMed
Savovic 2012
    1. Savovic J, Jones H, Altman D, Harris R, Juni P, Pildal J, et al. Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta‐epidemiological studies. Health Technology Assessment 2012;16:1‐82. - PubMed
Schnebel 1989
    1. Schnebel BE, Evans JP, Flinn D. The use of a passive motion machine. American Journal of Knee Surgery 1989;2:131‐6.
Sheppard 1995
    1. Sheppard MS, Westlake SM, McQuarrie A. Continuous passive motion ‐ where are we now?. Physiotherapy Canada 1995;47(1):36‐9.
Smith 2007
    1. Smith TO, Davies L. The efficacy of continuous passive motion after anterior cruciate ligament reconstruction: a systematic review. Physical Therapy in Sport 2012;13:270‐8. - PubMed
van Dijk 2007
    1. Dijk H, Elvers J, Oostendorp R. Effect of continuous passive motion after total knee arthroplasty: a systematic review. Physiotherapy Singapore 2007;10:9‐19.
Videman 1987
    1. Videman T. Connective tissue and immobilization: key factors in musculoskeletal degeneration. Clinical Orthopaedics and Related Research 1987;221:26‐32. - PubMed
Viswanathan 2010
    1. Viswanathan P, Kidd M. Effect of continuous passive motion following total knee arthroplasty on knee range of motion and function: a systematic review. New Zealand Journal of Physiotherapy 2010;38:14‐22.

References to other published versions of this review

Harvey 2010
    1. Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database of Systematic Reviews 2010, Issue 3. [DOI: 10.1002/14651858.CD004260.pub2] - DOI - PubMed
Milne 2003
    1. Milne S, Brosseau L, Robinson V, Noel MJ, Davis J, Drouin H, et al. Continuous passive motion following total knee arthroplasty. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD004260] - DOI - PubMed

Publication types

MeSH terms