Continuous passive motion following total knee arthroplasty in people with arthritis

  • Conclusions changed
  • Review
  • Intervention

Authors

  • Lisa A Harvey,

    Corresponding author
    1. The University of Sydney, Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, Ryde, NSW, Australia
    • Lisa A Harvey, Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, PO Box 6, Ryde, NSW, 1680, Australia. l.harvey@usyd.edu.au.

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  • Lucie Brosseau,

    1. University of Ottawa, School of Rehabilitation Sciences, Faculty of Health Sciences, Ottawa, Ontario, Canada
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  • Robert D Herbert

    1. The George Institute for International Health, University of Sydney, Centre for Evidence-Based Physiotherapy, Musculoskeletal Division, Sydney, New South Wales, Australia
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Abstract

Background

Total knee arthroplasty is a common intervention for patients with arthritis. Post-surgical rehabilitation often includes continuous passive motion. However, it is not clear whether continuous passive motion is effective.

Objectives

To evaluate the effectiveness of continuous passive motion following total knee arthroplasty in people with arthritis.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (January 1966 to January 2009), EMBASE (January 1980 to January 2009), CINAHL (January 1982 to January 2009), AMED (January 1985 to January 2009) and PEDro (to January 2009).

Selection criteria

Randomised controlled trials in which the experimental group received continuous passive motion, and both the experimental and control groups received similar postoperative care and therapy following total knee arthoplasty in people with arthritis.

Data collection and analysis

Two reviewers independently selected trials for inclusion. Data were then extracted and the quality of trials assessed. The primary outcomes were active knee flexion range of motion, passive knee flexion range of motion, active knee extension range of motion, passive knee extension range of motion, length of hospital stay, function and incidence of manipulation under anaesthesia. The secondary outcomes were pain, swelling and quadriceps strength. Effects were estimated as weighted mean differences or standardised mean differences with 95% confidence intervals (CI). Meta-analyses were performed using random-effects models for continuous variables.

Main results

Twenty randomised controlled trials of 1335 participants met the inclusion criteria. There is high-quality evidence that continuous passive motion increases passive knee flexion range of motion (mean difference 2 degrees, 95% CI 0 to 5) and active knee flexion range of motion (mean difference 3 degrees, 95% CI 0 to 6). These effects are too small to be clinically worthwhile. There is low-quality evidence that continuous passive motion has no effect on length of hospital stay (mean difference -0.3 days; 95% CI -0.9 to 0.2) but reduces the need for manipulation under anaesthesia (relative risk 0.15; 95% CI 0.03 to 0.70).

Authors' conclusions

The effects of continuous passive motion on knee range of motion are too small to justify its use. There is weak evidence that continuous passive motion reduces the subsequent need for manipulation under anaesthesia.

摘要

背景

術後連續被動運動對全人工膝關節置換術患者之效果

全膝人工關節置換術為常見治療退化性關節炎及類風濕性關節炎之一。術後連續被動運動為常見復建方式,但其效能與否仍無定論。

目標

本統合分析研討全膝人工關節置換術患者術後連續被動運動之效果。

搜尋策略

搜尋MEDLINE (196 o 2002), EMBASE (1988 to 2002), CINAHL (1982 to 2002), HEALTH STAR (1991 to 1994) and CURRENT CONTENTS (1997 to 2002)。

選擇標準

只收隨機對照試驗。治療組與安慰劑組皆接受物理治療,治療組也接受術後連續被動運動。

資料收集與分析

兩位作者使用預定條件獨立進行資料摘錄,並對每篇試驗研究的品質進行評估。結果分析:主動與被動膝關節活動度、住院時間、疼痛、腫脹及四頭肌強度。本文使用固定效應模型(fixedeffects model)分析,若有異質性,則用隨機效應模型(randomeffects model)分析。 連續性資料使用加權平均差異(weighted mean difference:WMD)來分析,若相同概念但使用不同衡量單位則使用標準平均差異(standardized mean difference:SMD)來分析。二分法的資料使用相對風險(RR)來表示。

主要結論

14個研究共1335位病患包含於分析中。結果傾向於物理治療加連續被動運動比單純物理治療好。連續被動運動可增加主動與被動膝關節彎曲度,但臨床效果有限,對於減少住院天數則無明顯證據,減少再次麻醉膝彎曲復健則有效。

作者結論

全膝人工關節置換術患者,短期復建結合物理治療加術後連續被動運動比單純物理治療好。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

膝關節置換術後連續被動運動:此Cochrane回顧摘要介紹了我們所知道的有關持續被動運動(CPM)作為治療,以改善膝關節置換手術後關節活動度和功能的效果。在開過膝關節置換術的患者:  連續被動運動可略為改善運動範圍 連續被動運動對於住院天數可能沒有任何差別,我們往往沒有確切有關副作用和併發症的資訊。尤其是罕見但嚴重的併發症。什麼是退化性關節炎,什麼是連續被動運動(CPM)?膝蓋退化性關節炎可以使膝關節疼痛和不穩定。膝關節置換術是一種治療,有時可以幫助這種情況。膝蓋手術有一個副作用是膝蓋會僵硬。當你的膝蓋僵硬時,可能很難從坐姿站立。直至一年後,有些人走路,上下樓梯可能會比手術前更慢。這導致了發展出一種療法稱為連續被動運動(CPM)。連續被動運動是一種運動,用機器提供你的膝蓋常規運動。這個運動是被動的,這意味著該機器會移動您的膝蓋透過預設的移動範圍。該運動會測試你的膝蓋運動範圍稱為屈曲。屈曲運動,是一個移動關節體的兩端讓他們彼此更加接近。在這種情況下,膝屈曲是盡可能讓你的腳跟靠近臀部。這個距離是用角度側量。膝關節置換手術後作CPM,最樂觀估計會發生什麼事:運動範圍  主動膝關節屈曲。沒有作CPM的患者能夠彎曲膝蓋,平均75度,有作CPM的患者可彎曲多3度以上,平均78度。運動範圍  被動膝屈曲。沒有作CPM的患者能夠彎曲膝蓋,平均82度,有作CPM的患者可彎曲多2度以上,平均84度。住院天數,沒有作CPM的患者平均住院13天,約等同有作CPM的患者。功能,在這次review中,我們無法獲得準確身體功能改變的匯集估計

Plain language summary

Continuous passive motion after knee replacement surgery

This summary of a Cochrane review presents what we know about the effect of continuous passive motion (CPM) as a treatment to improve range of motion and function after knee replacement surgery.

In people who had knee replacement surgery:

- Continuous passive motion improved their range of motion slightly;

- Continuous passive motion may not make any difference to how long they stayed in hospital;

We often do not have precise information about side effects and complications. This is particularly true for rare but serious complications. 

What is osteoarthritis and what is continuous passive motion (CPM)?

Osteoarthritis of the knee can make the knee joint painful and unstable. Knee replacement surgery is a treatment that can sometimes help this condition. One side effect of having knee surgery is stiffness in the knee. When your knees are stiff, it can be difficult to stand from a sitting position. Up to a year later, some people walk and climb stairs more slowly than they did before surgery.

This has led to the development of a therapy called continuous passive motion (CPM). Continuous passive motion is a way of providing regular movement to your knee using a machine. The movement is passive which means that machine moves your knee for you through a preset range of motion. The movement that tests the range of motion for your knee is called flexion. Flexion is a movement which moves the two ends of a jointed body part closer to each other. In this case, knee flexion is how close you are able to move the heel of your foot close to your buttocks. This distance is measured in degrees.

Best estimate of what happens to people who have CPM after knee replacement surgery:

Range of motion - Active knee flexion

- People who did not have CPM were able to move their knee an average of 75 degrees

- People who did have CPM were able to move their knee 3 degrees more, an average of 78 degrees.

Range of motion - Passive knee Flexion

- People who did not have CPM were able to move their knee an average of 82 degrees

- People who did have CPM were able to move their knee 2 degrees more, an average of 84 degrees.

Length of Hospital Stay

- People who did not have CPM stayed in hospital an average of 13 days, about the same as people who did have CPM.

Function

- We could not obtain an accurate pooled estimate of the changes to physical function in this review.

Ancillary