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Cryotherapy following total knee replacement.

Ashwin Aggarwal1,2, Sam Adie3, Ian A Harris1,2

  • 1School of Clinical Medicine, UNSW Medicine & Health, South West Sydney Clinical School, Sydney, Australia.

The Cochrane Database of Systematic Reviews
|October 30, 2025
PubMed
Summary
This summary is machine-generated.

Cryotherapy after total knee replacement (TKR) may reduce blood loss and pain, but evidence is low to very low certainty. More high-quality trials are needed to confirm benefits for knee function and other outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Rehabilitation Medicine
  • Evidence-Based Practice

Background:

  • Total knee replacement (TKR) is a common procedure for end-stage knee osteoarthritis, offering pain relief and functional improvement.
  • Acute post-TKR complications include pain, edema, and blood loss, with cryotherapy being a potential management strategy.
  • This review is an update of a 2012 publication on cryotherapy's efficacy in the acute phase post-TKR.

Purpose of the Study:

  • To evaluate the effect of cryotherapy within 48 hours after TKR on key post-operative outcomes.
  • Primary outcomes assessed include blood loss, pain, transfusion rates, range of motion, knee function, and adverse events.
  • The study aims to synthesize evidence from randomized controlled trials and controlled clinical trials.

Main Methods:

  • A comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase) and trials registers was conducted.
  • Included studies were randomized controlled trials or controlled clinical trials comparing cryotherapy with or without other treatments to control interventions.
  • Data extraction, risk of bias assessment, and certainty of evidence evaluation using GRADE were performed independently by two reviewers.

Main Results:

  • Low-certainty evidence suggests cryotherapy may reduce blood loss (MD 264 mL less) and slightly improve pain scores at 48 hours (MD 1.6 points lower).
  • Low-certainty evidence indicates cryotherapy may improve range of motion at discharge (MD 8.3 degrees greater).
  • Evidence is uncertain regarding cryotherapy's effect on transfusion rates, knee function, total adverse events, and withdrawals due to adverse events, with very low certainty.

Conclusions:

  • The certainty of evidence for most outcomes is low to very low, limiting definitive conclusions on cryotherapy's benefits post-TKR.
  • Potential benefits for blood loss, pain, and range of motion may be too small to justify clinical use.
  • Further well-designed randomized controlled trials focusing on clinically meaningful and patient-reported outcomes are required.