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    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
    I've worked in Orthopaedics for over 25 years. Cpm's have dramatically improved patients outcomes as well almost completely eliminated the need for a TKR patient to have a manipulation. The reason for all the studies to say there is no difference a year later is all the people not on a cpm device took them that long to recover after they needed a manipulation(15% to 17%). If the PT's were confident in their abilities they would see this as a viable modality and not something that threatens there job! The only cut I see Ortho's having is a cut of the PT clinic that is attached to their clinic not Home health companies. Maybe this is why so many therapist would like to see it gone!
    Posted by John on 6/7/2013 1:52 PM
    I'm a 39 yr old man who had TKA 2008, with the gift of MRSA. Regarding CPM, it is nothing more than a torture device! It was used against my will after the initial surgery in FT. Smith, AR. When seeing the second and third ortho surgeons in Denver each were appalled at the idea any surgeon would still use such a device. This was in 2008 during the removal of all hardware, replaced by a spacer (which crumbled), followed by the next TKA. I am now in Arkansas five years later and faced with another TKA. The current hardware failed after the cement cracked. The knee has become so lose my femur and tibia are now being damaged. I received a pre op call verifying equipment needed and was informed that one of these torture devices will be required in hospital and at home. I promptly informed them that under no circumstance would I be using it! After the other surgeries in Denver I managed to have total range of motion without the use of this device. I strongly recommend against the use of these torture devices as long as you are willing to endure the initial pain and walk ASAP post op followed by correct PT. You ALWAYS have the right to refuse anything you are not comfortable with. I believe the reason any ortho surgeon is using these horrific devices must be because they are getting some financial benefit from it.
    Posted by John Smith on 6/25/2013 9:21 PM
    The joint swinger actually "does" in five minutes what the CPM claims to do in 6-8 hours. I invented this to take patients off of glorified bed rest and get them up and moving with active recovery after their total knee or other knee surgery.
    Posted by Rob Vining on 11/9/2013 11:18 AM
    I'm 40 years old had a TKR a little over 6 weeks ago. I myself have to disagree with this article. I used a CPM every two hours then off two hours the first 2 days then used it twice a day 2 hours each time then I started going places and went to one time a day then missed a day. I can say when I didn't use the machine my knee was extremely stiff & my range of motion decreased, the only complaint I had was my thigh hurt like a son of a gun since I hadn't worked it out in a long time due to my knees being so bad for years. I was driving after the first week never used a cane crutches or walker. Four weeks after surgery I was riding my motorcycle I've put a little over 600 miles on it (Can Am Spyder 3 wheel)in the last 2 weeks. In my opinion if I didn't have the CPM in the first 3-4 weeks I don't think I'd be this far along. I understand everybody's body is different. My advice from my personal experience is if you're having a TKR soon the first questions I would ask your Dr. is do you put in a pain blocker (it's a ball with time release pain meds directly in the knee)lasts around 2 days & and do you prescribe a CPM? I hope this helps, also make sure to ice it regularly it's a key to keeping the pain away and swelling!
    Posted by Robert Fleming on 2/21/2014 10:34 PM
    CPM combined with PT is effective for short-term benefits and it's not designed for long-term benefits. In many cases the patients that have TKA don't live an active lifestyle and that's not going to change. I have seen many patients that are recovering fine while they are IP because they are forced to be active and regress upon discharge. CPM is very beneficial to help with stiffness in the early am as prior to therapy.
    Posted by DON-PT on 5/18/2014 11:04 AM
    I think the CPM has it's application just like anything else. If it's too cumbersome, or just too much, or if you're too lazy....just don't use it. It works
    Posted by Louis Iafrate -> AOVb@L on 7/2/2014 5:16 PM
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