Tuesday, July 03, 2012
New in the Literature: Continuous Passive Motion Post-total Knee Arthroplasty (J Arthoplasty. 2012; 27:193-200.)
Continuous passive motion (CPM) gives no benefit in immediate functional recovery post-total knee arthroplasty (TKA), and the postoperative knee swelling persisted longer, say authors of an article published in the Journal of Arthroplasty.
Researchers at the Department of Orthopaedic Surgery, Lilavati Hospital and Research Centre, in Mumbai, India, prospectively assigned 84 patients with TKA to 1 of the 3 standard rehabilitation regimes—no CPM, 1-day CPM, and 3-day CPM. They recorded a Timed Up and Go test, Western Ontario and McMaster Universities Index (WOMAC), and short form-12 (SF-12), in addition to range of motion, knee and calf swelling, pain, and wound healing parameters.
Standardized and elaborate measurements preoperatively and on postoperative days 3, 5, 14, 42, and 90 showed no statistically significant difference among the 3 groups in each parameter.
Comments
Let's make the recommendation again to stop these things. THANKS GINA!!!!
Posted by Pati
on 7/3/2012 8:05 PM
Recently, ALL of my TKA clients (8) have arrived s/p hospital stay with orders for CPM at very conservative protocols. i.e. 0-60 degrees, advance 5-10 degrees per day. Different ortho docs as well and clients with uncomplicated Hx. What the heck???
Posted by Anthony Woods -> >MPbDN
on 7/5/2012 8:02 PM
I speak from personal experience. The CPM
Is very irritating post TKR. I was perfectly capable of moving my own knee ! I asked for it to be removed.
My outcome was excellent with 120 degrees fle ion in 2 weeks.
Posted by Lesley Freeling
on 7/6/2012 9:23 PM
Will someone PLEASE clue in orthopedists to this fact?? PTs have known this for YEARS!
Posted by Mitzi Hazard
on 7/7/2012 12:19 AM
One more example of much of modern medicine being unscientific, unnecessary, and likely harmful. I made a recommendation to the ortho section to stop them in the mid 90's, because there already was enough evidence of their not impacting outcomes in a positive way. As Nassir Ghaemi, M.D., MPH says "medicine of the believer, not the knower".
Posted by Ed Scott PT, DPT, OCS
on 7/7/2012 4:56 AM
I took 13 years off to raise kiddos and since being back have been surprised to see many post surgical knee protocols have been knocked back to the late 80s, early 90s. Patients having same old complaints of brace/equipment ill fitting, irritation and migration in spite of having good strength and coordination. Bring back the pre surgical consults so patients know what is expected of their own efforts and get rid of the ineffective equipment use!
Posted by Keith Benson
on 7/8/2012 10:48 AM
Possibly there are ownership links between referral sources and DME providers? It is the case.
Posted by Isthe Truth
on 7/13/2012 11:01 PM
I haven't seen a CPM in years. We just get people up and walk, sometimes the same day of surgery! Outcomes are much better, and people are much happier with the results. Most are home within three days after rigorus rehab like protocol. No CPMs included.
Posted by Laura Laube, PT
on 7/13/2012 11:15 PM
I have taught a joint replacement course nationally for the last 5 years and my 20 year CINHL, Pedro , Cochrane Review literature clearly states no long term benefit to CPM-John O'Halloran
Posted by John O'Halloran
on 7/15/2012 11:13 AM
My best recoveries have been with 80+yr old women without CPM use, full recovery in 4 weeks to six weeks walking with cane or nothing, no complaints of pain. My 50 -65 year old women have had the most challenging recoveries but they were all obese. CPM machine only used on one, a bilateral.
80+ still is the greatest generation!
Posted by Maryanne
on 7/16/2012 4:13 PM
I'd like to see a study that includes parameters such a patient's perception of pain and recovery, use of pain medication and side effects - such as constipation and nausea and subsequent treatment for those issues. I'm a PT with 30+ years of experience and I've undergone 4 extensive knee surgeries on the same knee. I vote FOR the CPM. With it's use I had less pain and excellent increase in ROM. I used the DonJoy ice machine with the CPM and that controlled the edema. My experience with OP Ortho PT clinic and Home Health - let the patient have a say! Those who are physically comfortable with the device do very well. The patients that do not do well w the device usually have trouble w positioning many times due to back issues. One treatment does not fit all patients and studies do not take into account all the various factors.
Posted by Ellen
on 8/11/2012 9:16 PM
Ortho surgeons continue to use CPM's because they have a cut with the company that supplies the CPM. These doctors know that CPM is not effective but they will do anything for money. So, sadly, this is the case everywhere!!
Posted by SouthPhillyPT
on 8/13/2012 5:33 PM
I have extensive practice of 45 yrs. My wife just had R TKR. CPM was ordered. The setting post op was 40 degrees though range was 65 degrees. Duration 3 hrs daily.This actually retarded her progress. My approach is to tolerance with volitional override flexion/extension. Device is only valuable as dynamic volitional exercise plinth for all critical functional measures. I t did not come home with her!
Posted by robert derrickson pt
on 10/24/2012 4:53 AM
I also think the CPM keeps them in the bed longer vs. getting up and moving about. They just seem cumbersome and take away time from other important aspects of the rehab.
Posted by Tracy
on 1/12/2013 9:55 AM