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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.


    • 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

    • CPM was incredibly helpful to me with my ACL reconstruction (night use) I'm a hand therapist and use it for patients with post surgical joint releases for one. As the name implies continuous motion gently through an entire arc of motion can never be underrated and if used properly (even if just at night when joint might otherwise be "immobile" for 6-8 hours) is beneficial. Need to study CPM with good protocols outlined and followed

      Posted by Chris on 10/11/2014 11:02 AM

    • Has anyone had back problems after using the CPM? I am short and have been told it may have irritated by back. After surgery my Dr.wanted me to use this machine 3-6 hours daily. While my knee caused me no problems my pain was from the charlie horses in by butt ox. I now have 3 herniated disks! Anyone out there have a similar issue.

      Posted by Judy on 1/25/2015 4:41 PM

    • I am a retired nurse and have had a TKR. The CPM. Is a blessing. I had severe pain with positioning after surgery and this machine relieved 50% of it. My husband was suppose to have one after his revision of a TKR but the V.A. refused him. We got a RX and paid 375$ out of our own pocket because we know it helps .He is looking at another TKR so we are considering purchasing one. This research proves nothing.

      Posted by Carol on 2/23/2015 11:51 AM

    • I have been a PT for 25+ years. I have seen large numbers of TKA patients who have and have not used CPM. I have definately come to the conclusion that the CPM patients do better from a pain, ROM and mobility perspective quicker than the non-CPM patients WHEN THE CPM IS USED PROPERLY. Common mistakes: Poor fit/axis not lined up. Harness that that leg lies on is too loose - this needs to be tightened daily. Speed to fast - I often see this at 60 degrees/min - should be 30 degrees/min so the leg barely perceives the movement and stays relaxed. I see patients do better 3 times/day for 1-1.5 hrs over 2-3 weeks.First session keep flexion the same, second session increase flex 2-3 deg, third seesion increase flex 2-3 deg. More frequent use prevents knee from stiffening too much between sessions and therefore when it is reapplied is tolerated better. I also recommend 5 minutes of "Hang time" after each CPM session to reach full extension. Unfortunately I am seeing CPM used less because of recent studies but I am not sure they are looking at How the CPM is applied.

      Posted by Andy McDonnell,PT on 4/3/2015 12:27 PM

    • The CPM has been a lifesaver for me. I had a TKR, ,but my case has a lot of variables and is more complex than most. I do have fo have manipulafion, but not for lack of doing my exercises or for using the CPM machine. The CPM has been my best form of pain control. I'm lucky to get 2-3 hours of sleep without the CPM. It's the only thing that helps me to sleep at night and if I experience a lot of pain or stiffness during the day, it provides relief while icing.. I got a new PT who wanted me to stop using it, but after 2 days witout it, I went to Emergency at the hospital due to severe pain and little sleep. The ER doctor said if it works for you, use it. In conclusion, everyone and each case is different, so if it benefits them they should use it if it doesn't then they shouldn't. As for me, I'd rather switch PTs again than ditch my CPM.

      Posted by Teresa on 4/16/2015 8:48 PM

    • I had a ConforMIS knee replacement last October. I used the CPM for 3 three weeks. Best thing ever!! I used it all night every night and when I was lying down during the day. My knee is doing great. I personally think you need to use it. That, along with physical therapy, will get you back in shape in no time. I am 68 years old and not overweight. I had a great doctor. My physical therapists have told me I have done better than any patient they have had. Ask for that CPM. It is not torture.

      Posted by Vandolyn on 5/3/2015 7:12 PM

    • I had right TKR 6 weeks ago and used the CMP machine for a month. Since the CMP machine was picked up 2 weeks ago, I have seen my range of motion decrease and swelling increase. I sitting here thinking of calling my Doctor to get another machine. My PT said it was a useless machine but I know how it made me feel.

      Posted by Michael LeCoq on 7/6/2015 3:01 PM

    • I LOVE how almost every comment on here comes from PT's. Here's the real scoop on CPM's...they work just the same as PT classes and save the Insurance company $$$$$(thousands). Also, Dr's don't get paid to dish out CPM orders...maybe back in the late 90's, but not these days. Bottom line is there are PLENTY of study's showing that CPM's work...the reason PT's hate them is that they cut into the bottom line. If the pt gets the same results as using the CPM as they would going to PT, then obviously the PT clinics would hate this.

      Posted by T on 7/8/2015 12:35 PM

    • While in the hospital, after my surgery in 2010, I was getting 135 to 140 degrees of movement while on the CPM. After I left the hospital and went only with traditional physical therapy, I lost all that movement and now live with just 100 degrees of movement. That makes it very painful and very difficult to even put my socks on. I highly recommend to EVERYONE that they insist on getting a CPM after leaving the hospital. Mark

      Posted by mark m. on 11/17/2015 1:42 PM

    • Used the CPM with both TKRs--one in April and one in September. Greatest invention since sliced bread. I would have paid the second time if Medicare hadn't. Perhaps someone reading these comments will notice that not everyone heals and recovers the same way.

      Posted by Linda Margulies on 12/10/2015 11:26 AM

    • Isn't medical research great? Yes..Yes.Maybe.Maybe.No. Sprinkle it with ulterior motives and you have the story of the human condition..Combined with the ice machine and a Dyna Splint, I think the CPM device relieves stiffness which in turn contributes to ROM.But then I am a VA client and they seem to be less concerned about cutting corners.

      Posted by Mike Brewer on 5/3/2016 3:20 PM

    • I ws in the CPM business for over 25 years. We set up 7-8000 patients a year. We taught each patient how to operate the CPM and how to progress their range of motion. I cannot recall a patient complaining about the machine, and I can also say that very few patients had to go in and have a manipulation. Rather than work on range of motion, the therapists were able to spend their limited time with the patient working on strengthening and activities of daily living. At less than 20 dollars a day, CPM is the most economical product on the market for a total knee replacement patient. It is sad that now Medicare charges the doctor if he orders a CPM. It is also interesting to note that Physical Therapists are against CPM. The therapist has limited time with the patient. Yes, a patient will get their range of motion, but at what cost? Why not make it easy on the patient.

      Posted by Mike Salem on 6/1/2016 12:11 AM

    • I have had 2 TKA. With both I used CPM in junction with active PT exercises. The CPM was very helpful in ROM when used as a supplement to PT. In both TKA cases, I was off a walker in 3 days post-op and walking with a cane in 4 days and without a cane in 7 days. Now, patients are discouraged to use CPM by their physicians based on flawed study. I have a Ph.D in Statistics and Research Design. Too many referenced studies are not based on proper, valid reproach designs and are misleading.

      Posted by Dennis Winsten on 7/16/2016 10:48 AM

    • I had my last surgery 7/19 bor broken tibia, fibula and torn tibia plateau repair. While I was at Harborview Medical Center in Seattle, I could use the CPM machine and try it out. It worked great. Going home, I learned that Medicare did an across-the-board denial on all CPMs whose injury wasn't for total knee replacement. So, now I am going to appeal this decision and ask for them to approve the CPM and also ask for a peer to peer review board to appeal: my doctor appealing the Medicare doctors. $600.00 a month plus is just too much. I am retired and don't have that income anymore.

      Posted by Katie Martell on 7/25/2016 1:36 PM

    • Went straight from the OR to my hospital room in a CPM machine. Used it in conjunction with PT during and after discharge from hospital. I used as prescribed and walked into my 2 week post op visit ambulating without a walker or cane. Getting ready to have TKA on the opposite knee soon. Plan on using it again! Oh, and I am 80 years old! USE IT!!!!

      Posted by William Grubb on 11/26/2016 6:57 PM

    • I can't imagine going through TBA without CPM. I had only cpm therapy for the first 5 days before going to rehab. Hospital PT'so dropped the ball on my pt and without the cpm and my own proactiveness I wouldn't be able to ambulate as well as I am. The rehab facility team was surprised that I had achieved over 90°ROM on my own with ONLY cpm and my own determination. So don't believe all the hype about this device not working because I personally feel that it has been critical in my return to normal activities.

      Posted by PATRICIA A. REED on 4/5/2017 10:40 AM

    • I am four weeks postop TKR My experience with the CPM was horrible- not because of any fault of the machine but of the operators using it. Not only was the machine set at the wrong angle my first and only session was 5 1/2 hours long . That session ended when I began having a spasm in my hip . When I first noticed the spasm I asked the nurse to turn the machine off and take my leg out but I was told the machine needed to work the kinks out . As the pain quickly started to increase and run down my leg I began screaming to please turn it off and I explained several times that my knee was fine but it was the spasm in my hip that was causing my pain . They still forced me to stay in the machine for another 15 minutes until I began hyperventilating crying and dry heaving. The doctor explained to me that the situation had irritated my piriformis muscle and created an attack of sciatica which I am still dealing with today . My knee has truly not giving me very much pain at all but my hip, lower back and foot have prevented me from having PT until yesterday. Because of the sciatica I have not been able to sit for more than a couple of minutes or stand because of my swollen foot . That said the time that I have spent in bed I have twisted and turned and contorted myself in all sorts of fashions and amazingly my flexion is that 122° and my extension is a -1 . In a few months I plan to have TKR on the other side and I also intend to use the CPM machine but I will Make sure the machine is used properly and I will be in total control of the power cord!!!!

      Posted by Dharla Price on 5/11/2017 1:18 PM

    • I am three weeks post op and have used the CPM machine for about four hours per day every day since I came home. I only use the CPM machine once on the days I have at home PT. Next week I will begin outpatient PT and I expect the CPM machine will be picked up. I purchased an inexpensive pedal machine and it will work much like the CPM but I will be sitting in a chair. I truly believe the CPM machine has helped me increase the flexibility and range of motion.

      Posted by Janice on 6/23/2017 3:39 PM

    • Has anyone ever experienced or heard of patients suffering injuries as a result of using a CPM? My mother was injured using a CPM she told us because post op day one the aide set up the machine wrong to start at 120 degrees and my mom was nearly flat on her back instead of inclined. This caused her leg to jam up into her abdomen. Can this happen with the CPM machine? Any help in understanding how the machine works would be appreciated thank you!

      Posted by Sheila Peterson on 8/18/2017 12:22 PM

    • I had a knee replacement on September 12 and was put on a cpm 3 times a day 2 hours at a time, left hospital at 80 degrees, with orders to increase 10 degrees a day.. I have a back with terrible osteoarthritis with a l2-l4 fusio with 2 cages I'm my spine. I was told I could use it how I wanted to as long as I got in 6 hours a day. About a week out of surgery I started getting a burning feeling on front of thigh on leg workout surgery, and had reached 105 degrees.. Then a couple days later it became a burning stab down leg leaving it numb. So I adjusted usage and stayed off it for a day to let back calm down, then restarted it at 80 degrees and after 30 minutes on it started getting that burning feeling , only this time it started pain I'm my testicles. So I am going to discontinue usage.

      Posted by Jeff DeWeese on 9/23/2017 8:55 PM

    • I had a fall during Hurricane Irma ( Sept 15th). This resulted in smashing my left knee patella into about 20 pieces. I had emergency repair surgery 2 days later. The doctor put is a woven mesh product to heal the bones together, removed the smallest pieces and added two screws. As of this last wednesday I had less than 30 degrees of flexion. PT was not helping me. I started it six weeks after surgery. I was full of anxiety, tears and fear . I simply cannot FORCE the knee to bend. I was having a hard time even lifting it off the table at PT. I ended up trying a Feldenkraus method of regaining strength and control over the knee and my balance.I am still seeing that therapist. I ordered a CPM machine and have now been on it for four days about 8 to 10 hours per day. I have increased from the 30 degrees to 45 in the last four days. Can anyone recommend exercises to do AFTER using the machine? Currently to top it all off I had neuromas in both feet on the mother branch of the nerves PRIOR to the fall and those unfortunately are keeping me from standing. I am trying to heel the knee and my Podiatriatic surgeon is treating the neuromas....One bit more of info I weigh less than 120 lbs. So weight is not an issue. I am 55.

      Posted by denise e collette on 3/12/2018 10:35 PM

    • Very interesting dialogue written on the controversies regarding CPM usage. This topic is very important to me for a number of reasons. First, I have been a licensed PT for 22 years and used CPM's on both the inpatient and outpatient side. Second, I am currently the president and an owner in a national DME company specializing in post-op orthopedic products, including CPM. We currently do business in 31 states across the US and have seen a number of trends in CPM utilization. We do see some MD's and facilities stopping the use of CPM, but we are seeing a growing trend of orthopedic surgeons going back to CPM usage, but in a slightly different capacity. I don't think I will get any argument that ROM following a TKR, or any knee surgery for that matter, is a critical variable to a successful outcome. In an environment where innovative payment models such as BPCI Advanced or commercial bundles are now a popular form of payment, CPM, when used correctly, is the most affordable form of home rehabilitation on the market. It is not a replacement for the skilled services of a PT, but can work hand in hand with a PT to deliver a great patient outcome at an affordable price. Our current CPM technology operates off of an Android tablet, which allows us to monitor utilization, interact with the patient, set goals, provide feedback, reduce re-admissions, provide customized video based exercise, and collect data. We are finding that the old protocols of CPM 2-3x/day for 6-8 hours a day are completely unnecessary. Our data is showing that CPM for a total of 90 minutes a day for 30 min per session gets excellent results, 0-125 degrees within 3 weeks. The key is patient compliance, reinforcement of DC instructions, patients being responsible for their own successful outcomes, and the right treatment at the right time. New technology CPM is an effective tool in the post-op treatment of knee and shoulder injuries.

      Posted by Mike Buckholdt on 4/17/2018 10:44 AM

    • Day 2 after knee replacement is by far the worst, the only relief I receive is being on the CPM. I would like to be in it all night but not sure if that will set me back or not. I have a pain pump, oxy and norco and still no relief unless i'm in the CPM.

      Posted by Angela McCollum on 2/9/2019 3:06 AM

    • I've provided CPM machines in both the hospital and home settings since 1986. There is absolutely no doubt that patients who utilize a properly applied CPM machine recover faster than those who do not. There is also absolutely no doubt that there is an aggressive movement by hospital and physician office Physical Therapists to cease the use of CPM in order to maximize their billable hours for post operative rehabilitation following total knee replacement. This is not beneficial to the patient's recovery or long term prognosis and is just plain wrong from a care perspective. I've set up thousands of patients on CPM and never once had one need a manipulation, which isn't always the case when CPM is not used. Bottom line, they work and are far more cost effective than PT alone.

      Posted by Alan Bieling on 3/19/2019 3:02 PM

    • After 8 days, I cannot tolerate this machine. When I was all drugged up, I fell asleep in it. Now I cannot stand it. And it hurts my left hip.

      Posted by Sue fortier on 3/26/2019 9:11 PM

    • I had a block with r. knee arthroplasty and still felt nothing from the waist down, when I looked over to see heavy CPM machine had fallen from hospital bed with my leg strapped in. At a minimum, this pulled the muscles in my leg and the surgical incision. If these machines are going to be used, it it should be done with greater care.

      Posted by Linda Kathleen Morreale on 6/1/2019 12:34 AM

    • I love the CPM machine it's helped my knee tremendously I'm in week 3 and I'm at 103 degree I recommend it to everyone it was easy painless and really helped.

      Posted by Cindy Burch on 11/23/2019 9:30 PM

    • I agree with all the one sided comments and statistical evidence dismissing the efficacy of the CPM. However, I’ve had one arthroscopy and two knee replacements and when taking my PT, I’ve found a huge reduction in pain. It’s interesting the human behavior when arguing for or against any side. Seems there is a general fear to make even the smallest of comments against the personal bias. Because of all the negative reviews, it’s darn near impossible to find a cpm. Well, I just had my second knee implant and did manage to locate one and will sleep with it running. And tomorrow when I go for PT, I will experience less pain. It’s not a waste of time for me to avoid or minimize significant pain. NOTE: Do not use the CPM as a replacement for PT. Use it as a precursor to your PT and your overall pain experience will lessen.

      Posted by Nick P on 12/23/2019 8:08 PM

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