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Intervention Review

Continuous passive motion following total knee arthroplasty

  1. Sarah Milne2,
  2. Lucie Brosseau1,*,
  3. Vivian Welch3,
  4. Marie-Josee Noel4,
  5. J Davis5,
  6. Hugo Drouin6,
  7. George A Wells7,
  8. Peter Tugwell3

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 23 FEB 2003

DOI: 10.1002/14651858.CD004260

Database Title

Additional Information

How to Cite

Milne S, Brosseau L, Welch V, Noel MJ, Davis J, Drouin H, Wells GA, Tugwell P. Continuous passive motion following total knee arthroplasty. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD004260. DOI: 10.1002/14651858.CD004260.

Author Information

  1. 1

    University of Ottawa, School of Rehabilitation Sciences, Faculty of Health Sciences, Ottawa, Ontario, Canada

  2. 2

    Children's Hospital of Eastern Ontario, Rehabilitation Center, Ottawa, Ontario, Canada

  3. 3

    University of Ottawa, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

  4. 4

    Federal Government of Canada, Ottawa, ON, Canada

  5. 5

    Birmingham Women's Hospital, NHS Trust, Medical Education, Birmingham, UK

  6. 6

    Ottawa, Canada

  7. 7

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

*Lucie Brosseau, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. lbrossea@uottawa.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Knee arthroplasty (KA) is a common intervention that can enhance the quality of life for patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Post-surgery rehabilitation protocols often include continuous passive motion (CPM). However, CPM protocols vary considerably amongst institutions.

Objectives

The purpose of the current meta-analysis is to evaluate the effectiveness of continuous passive motion following total knee arthroplasty.

Search strategy

An electronic search of MEDLINE (1966 to 2002), EMBASE (1988 to 2002), CINAHL (1982 to 2002), HEALTH STAR (1991 to 1994) and CURRENT CONTENTS (1997 to 2002) was conducted to identify randomized controlled trials.

Selection criteria

Following an a priori protocol, only randomized controlled trials of CPM for the treatment of participants post KA were eligible. Subjects were 18 years of age or older and had a pre-surgery diagnosis of degenerative joint disease. Both the experimental and control groups received physiotherapy. In addition to the physiotherapy intervention, the experimental group received CPM.

Data collection and analysis

Two reviewers independently selected trials for inclusion. Data were then extracted and the quality of the trial assessed using predetermined forms. Outcome measures of interest were: active and passive knee range of motion (ROM) length of hospital stay, pain, swelling and quadriceps strength. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed; in which case, a random effects model was used. Results were analyzed as weighted mean differences (WMD) with 95% confidence intervals (CI). Standardized mean differences (SMD) were used when different scales were used to measure the same concept (e.g. pain). Dichotomous outcomes were presented as a relative risk.

Main results

Fourteen trials were retained for analysis. Results favouring CPM were found for the main comparison of CPM combined with physiotherapy (PT) versus PT alone at end of treatment. For the primary outcomes of interest, CPM combined with PT was found to statistically significantly increase active knee flexion (WMD 4.30 degrees, 95% CI: 1.96, 6.63) and decrease length of stay (WMD -0.69 days, 95% CI: -1.35, -0.03). CPM was also found to decrease the need for post-operative manipulation (RR 0.12, 95% CI: 0.03, 0.53). CPM did not significantly improve passive knee flexion and passive or active knee extension.

Authors' conclusions

CPM combined with PT, may offer beneficial results compared to PT alone in the short term rehabilitation following total knee arthroplasty.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Continuous passive motion following total knee arthroplasty

Continuous passive motion combined with physiotherapy offers beneficial results compared to physiotherapy alone in the short term rehabilitation following total knee arthroplasty.

Continuous passive motion is a commonly used device post knee arthroplasty. This review of 14 studies (952 participants) found significant improvements in active knee flexion and analgesic use two weeks post-operatively with the use of continuous passive motion and physiotherapy compared to physiotherapy alone. In addition, length of hospital stay and need for knee manipulations were significantly decreased in the continuous passive motion group. Continuous passive motion combined with physiotherapy may offer beneficial results for patients post knee arthroplasty. However, the potential benefits will need to be carefully weighed against the inconvenience and expense of CPM. More research is necessary in order to assess the differences in effectiveness with different characteristics of application such as total duration of treatment and intensity of CPM interventions.

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