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Continuous passive motion with accelerated flexion after total knee arthroplasty
A A Yashar1, E Venn-Watson, T Welsh
1Bluegrass Orthopaedic Group, Louisville, Kentucky, USA.
Clinical Orthopaedics and Related Research
|January 7, 1998
Summary
Accelerated continuous passive motion (CPM) after total knee arthroplasty improves early flexion. However, this approach does not significantly alter long-term outcomes or increase complication risks compared to traditional CPM.
Area of Science:
- Orthopedic Surgery
- Rehabilitation Medicine
- Biomechanical Engineering
Background:
- The efficacy of continuous passive motion (CPM) following total knee arthroplasty (TKA) is debated.
- Optimizing early knee flexion is crucial for patient recovery and function post-TKA.
Purpose of the Study:
- To evaluate the impact of an accelerated CPM protocol, initiated at higher flexion angles in the recovery room, on early range of motion and overall outcomes after TKA.
Main Methods:
- A randomized prospective study involving 210 patients undergoing TKA at two institutions.
- Group I received accelerated CPM (70-100 degrees flexion) in the recovery room.
- Group II received standard CPM (0-30 degrees flexion, progressing to 100 degrees).
Main Results:
- Group I demonstrated significantly greater knee flexion on postoperative Day 3 (82.5 vs 72.8 degrees) and at discharge (89.1 vs 84.3 degrees).
- No significant differences in flexion were observed between groups at 4 weeks, 6 weeks, 12 weeks, or 1 year post-surgery.
- One case of wound necrosis in Group I was attributed to dressing tightness, not the CPM protocol itself. No significant differences in pain, blood loss, or major complications were noted.
Conclusions:
- Initiating CPM at higher flexion angles (70-100 degrees) in the recovery room can increase early postoperative knee flexion after TKA.
- This accelerated approach does not appear to increase risks of complications, pain, or blood loss.
- While beneficial for early mobility and potentially facilitating earlier discharge, accelerated CPM did not lead to improved final functional outcomes at follow-up periods of 4 weeks or longer.