A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. Beneficial effects of continuous passive motion after total condylar knee arthroplasty. Use of Inpatient Continuous Passive Motion Versus No CPM in Computer‐Assisted Total Knee Arthroplasty Continuous Passive Motion After Total Knee Arthroplasty: A Prospective Study Continuous passive motion after total knee arthroplasty. To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery. Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients. A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. Effect of adjunctive range-of-motion therapy after primary total knee arthroplasty on the use of health services after hospital discharge. Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Continuous passive motion as an adjunct to active exercises in early rehabilitation following total knee arthroplasty – a randomized controlled trial Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Use of continuous passive motion after total knee arthroplasty. The influence of continuous passive motion on the results of total knee arthroplasty. [The effects of two different continuous passive motion protocols on knee range of motion after total knee arthroplasty: a prospective analysis].
OBJECTIVE To evaluate the efficacy of continuous passive motion ( CPM ) in the postoperative management of patients undergoing total knee arthroplasty . DESIGN A r and omized controlled single-blind trial of CPM plus st and ardized rehabilitation vs st and ard rehabilitation alone . SETTING A referral hospital for arthritis and musculoskeletal care . PATIENTS Consecutive patients with end-stage osteoarthritis or rheumatoid arthritis undergoing primary total knee arthroplasty who had at least 90 degrees of passive knee flexion . One hundred fifty-four patients were eligible and 102 patients agreed to participate and were r and omized . Ninety-three patients completed the study protocol . INTERVENTION Continuous passive motion machines programmed for rate and specified arc of motion within 24 hours of surgery with range increased daily as tolerated with st and ardized rehabilitation program compared with st and ardized rehabilitation program alone . MAIN OUTCOME MEASURES Primary outcomes were pain , active and passive knee range of motion , swelling ( or circumference ) , quadriceps strength at postoperative day 7 , as well as complications , length of stay , and active and passive range of motion and function at 6 weeks . RESULTS Use of CPM increased active flexion and decreased swelling and the need for manipulations but did not significantly affect pain , active and passive extension , quadriceps strength , or length of hospital stay . At 6 weeks there were no differences between the two groups in either range of motion or function . In this series , use of CPM result ed in a net savings of $ 6764 over conventional rehabilitation in achieving these results . CONCLUSION For the average patient undergoing total knee arthroplasty , CPM is more effective in improving range of motion , decreasing swelling , and reducing the need for manipulation than is conventional therapy and lowers cost Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty . Although research suggests that Continuous Passive Motion ( CPM ) should be implemented in the first rehabilitation phase after surgery , there is substantial debate about the duration of each session and the total period of CPM application . A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion . It also suggested , however , that future research should concentrate on the treatment period during which CPM should be administered . Methods In a r and omised controlled trial we investigated the effectiveness of prolonged  CPM  use in the home situation as an adjunct to st and ardised PT . Efficacy was assessed in terms of faster improvements in range of motion ( RoM ) and functional recovery , measured at the end of the active treatment period , 17 days after surgery . Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were r and omised over two treatment groups . The experimental group received CPM + PT for 17 consecutive days after surgery , whereas the usual care group received the same treatment during the in-hospital phase ( i.e. about four days ) , followed by PT alone ( usual care ) in the first two weeks after hospital discharge . From 18 days to three months after surgery , both groups received st and ardised PT . The primary focus of rehabilitation was functional recovery ( e.g. ambulation ) and regaining RoM in the knee . Results Prolonged use of CPM slightly improved short-term RoM  in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-st and ard PT programme . Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessment s. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM , routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered , since neither long-term effects nor transfer to better functional performance was detected . Trial Registration IS RCT There is insufficient information on continuous passive motion ( CPM ) parameters in total knee arthroplasty patients for optimal patient outcomes . We compared CPM duration and increments on active and passive range of motion ( ROM ) in patients who underwent a unilateral total knee arthroplasty due to degenerative joint disease . Forty-five total knee arthroplasty patients were r and omly assigned to either a control group , a short CPM duration ( 3 - 5 hours per day ) group with CPM ROM  increased 5 degrees twice daily , a short CPM duration group with CPM ROM  increased daily to patient tolerance , a long CPM duration ( 10 - 12 hours per day ) group with  CPM ROM  increased 5 degrees twice daily , or a long CPM duration group with CPM ROM  increased daily to patient tolerance . Active and passive flexion and extension were measured goniometrically on each postoperative day that the patient was treated by physical therapy . No statistically significant differences between groups were found for baseline and final postoperative ROM . The CPM groups did not maintain the parameters assigned and were combined , revealing an enhanced rate of change of flexion . Most patients opted for a CPM duration of between 4 and 8 hours per day and the patient-preferred CPM  incremental increase in ROM was 6 - 7 degrees/day A r and omised , controlled study of the use of postoperative continuous passive motion ( CPM ) and immobilisation regimen after total condylar knee arthroplasty was performed . CPM result ed in a significant increase in both the early and late range of knee flexion . This increase occurred in both rheumatoid and osteoarthritic patients . The improvement of 10 degrees at 12 months allowed additional important function to be attained . CPM result ed in significantly earlier discharge from hospital . It did not increase the clinical incidence of wound healing problems , nor did it significantly increase the postoperative fixed flexion deformity or the extension lag .  CPM can be recommended as a safe and effective modality to achieve more rapid and more successful postoperative rehabilitation after knee arthroplasty BACKGROUND Continuous passive motion ( CPM ) has shown positive effects on tissue healing , edema , hemarthrosis , and joint function ( L. Brosseau et al. , 2004 ) . CPM has also been shown to increase short-term early flexion and decrease length of stay ( LOS ) ( L. Brosseau et al. , 2004 ; C. M. Chiarello , C. M. S. Gundersen , & T. O'Halloran , 2004 ) . The benefits of CPM for the population of patients undergoing computer-assisted total knee arthroplasty ( TKA ) have not been examined . PURPOSE The primary objective of this study was to determine whether the use of CPM following computer-assisted TKA result ed in differences in range of motion , edema/drainage , functional ability , and pain . METHODS This was an experimental , prospect i ve , r and omized study of patients undergoing unilateral , computer-assisted TKA . The experimental group received CPM thrice daily and physical therapy ( PT ) twice daily during their hospitalization . The control group received PT twice daily and no CPM during the hospital stay . Both groups received PT after discharge . Measurement included Knee Society scores , Western Ontario McMaster Osteoarthritis Index values , range of motion , knee circumference , and HemoVac drainage . Data were collected at various intervals from preoperatively through 3 months . RESULTS Although the control group was found to be higher functioning preoperatively , there was no statistically significant difference in flexion , edema or drainage , function , or pain between groups through the 3-month study period Objective Continuous passive motion ( CPM ) has been shown to increase significantly the amount of knee flexion for patients with total knee arthroplasty in the acute care hospital . Whether there is any additional benefit to using CPM for these patients who are transferred to a rehabilitation hospital is not known . There have been no prospect i ve , r and omized , controlled studies in this area . Design Fifty-one such patients on an inpatient rehabilitation service were r and omly assigned to two groups . Group 1 ( n = 23 ) received CPM for 5 consecutive hours per day plus physical therapy , whereas group 2 ( n = 28 ) received only physical therapy .  Knee flexion was measured by a blinded physical therapist on admission , on the third and seventh days of hospitalization , and at the time of discharge . Results The results indicated no significant difference in passive range of motion between group 1 and group 2 . Patients in group 1 achieved an average increase in passive range of motion of 16 degrees , whereas those in group 2 achieved an average of 19 degrees ( P = 0.33 ) . Conclusion Although power analysis indicated the need for differences in results for 32 patients per group to achieve significance , the difference between the two groups suggested neither statistical nor clinical significance . We concluded that the use of CPM in the rehabilitation hospital is likely of no added benefit to patients admitted after single total-knee replacement Sixty-two patients undergoing primary total knee arthroplasty were studied prospect ively . There were 42 patients in whom continuous passive motion ( CPM ) was used after surgery and 20 controls .  The two groups were comparable with respect to age , diagnosis , sex , weight , and preoperative deformity and motion . The mean length of time required for CPM patients to achieve 90 degrees of flexion ( 9.1 days ) was shorter than that for the control group ( 13.8 days ) . At the time of discharge from the hospital , however , there was no significant difference between the groups in amount of either flexion or extension .  All patients had  venograms performed after arthroplasty ; the incidence of positive studies indicating thrombophlebitis was 45 % in CPM patients and 75 % in controls . These data demonstrate that CPM after knee arthroplasty enables patients to recover motion more quickly and affords some protection against deep vein thrombosis Continuous passive motion ( CPM ) , though of doubtful value , is yet routinely practice d post-total knee arthroplasty ( TKA ) . We prospect ively distributed 84 patients with TKA to 1 of the 3 st and ard rehabilitation regimes : no-CPM , 1-day-CPM , and 3-day-CPM .  We recorded a unique " Timed up and go " test besides pain , Western Ontario and McMaster Universities ( WOMAC ) , short form-12 ( SF-12 ) , range of motion , knee and calf swelling , and wound healing parameters . Our st and ardized 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 . We concluded that CPM gives no benefit in immediate functional recovery post-TKA , and in fact , the postoperative knee swelling persisted longer . We have since then discontinued its use in our patients without any untoward effect 68 consecutive patients who had primary knee arthroplasties because of arthrosis were r and omized to postoperative continuous passive motion ( CPM ) or active physical therapy ( APT ) . Rehabilitation in both groups was initiated on the first postoperative day . The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group , but there were no differences between the groups in knee flexion at discharge . Postoperative pain rating and hospitalization times were similar in the two groups Effect of continuous passive motion ( CPM ) protocol s on outcomes after total knee arthroplasty . In this prospect i ve r and omized controlled study , 147 patients were assigned to 1 of 3 treatment groups : CPM from 0 degrees to 40 degrees and increased by 10 degrees per day , CPM from 90 degrees to 50 degrees ( early flexion ) and gradually progressed into full extension over a 3-day period , and a no-CPM group . The CPM was administered twice a day for 3 hours over a 5-day period . All patients participated in the same postoperative physiotherapy program . Patients were assessed preoperatively , day 5 , 3 months , and 1 year postoperatively . The early flexion group had significantly more range of flexion than both the st and ard and control groups at day 5 . There was no significant difference between the groups for any other variable tested at any time frame . Key words : total knee arthroplasty , CPM , rehabilitation , outcomes INTRODUCTION There is controversy as to whether continuous passive motion ( CPM ) after total knee arthroplasty ( TKA ) , which is the st and ard treatment , confers significant benefit with respect to outcome . The primary purpose of this study was to determine if CPM or slider-board ( SB ) therapy , used as adjuncts to st and ardized exercises ( SEs ) during the acute-care hospital stay , result ed in a reduced total length of hospitalization and post-discharge rehabilitation in patients who underwent primary TKA . METHODS We carried out a r and omized , clinical trial on 120 patients who received a TKA at the University of Alberta Hospital , Edmonton , a tertiary care institution . The study horizon began at the point of discharge from the hospital and continued up to 6 months after operation . Postoperatively , patients ( 40 in each group ) received CPM and SEs , SB therapy and SEs or SEs alone while in the tertiary Health service use was compared using transfer institution length of stay(LOS ) , post-discharge rehabilitation , readmission and complication rates and their associated costs . RESULTS There were no differences in health service use or costs among the 3 groups over the 6-month study . The rates of postoperative complications and readmissions also were similar among the groups . Increased health service use associated with knee flexion that was less than 60 degrees at discharge , but similar proportions of patients with poor knee range of movement ( ROM ) at discharge were found in each group . CONCLUSIONS This finding suggests that adjunctive ROM therapy , as used in this study , does not reduce health service use . Further research is required to determine if adjunctive ROM therapy after discharge from the surgical hospital decreases health service utilization in those patients who have poor knee ROM at the time of discharge BACKGROUND AND PURPOSE The primary purpose of this r and omized controlled trial was to determine which method of mobilization - ( 1 ) st and ardized exercises ( SE ) and continuous passive motion ( CPM ) , ( 2 ) SE and slider board ( SB ) therapy , using an inexpensive , nontechnical device that requires minimal knee active range of motion ( ROM ) , or ( 3 ) SE alone-achieved the maximum degree of knee ROM in the fIrst 6 months following primary total knee arthroplasty ( TKA ) . The secondary purpose was to compare health-related quality of life among these 3 groups . SUBJECTS The subjects were 120 patients ( n=40/group ) who received a TEA at a teaching hospital between June 1997 and July 1998 and who agreed to participate in the study . METHODS Subjects were examined preoperatively , at discharge , and at 3 and 6 months after surgery . The examination consisted of measurement of knee ROM and completion of the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) . RESULTS The 3 treatment groups were similar with respect to age , sex , and diagnosis at the start of the study . There were no differences in knee ROM or in WOMAC Osteoarthritis Index or SF-36 scores at any of the measurement intervals . The rate of postoperative complications also was not different among the groups . DISCUSSION AND CONCLUSION When postoperative rehabilitation regimens that focus on early mobilization of the patient are used , adjunct ROM therapies ( CPM and SB ) that are added to daily SE sessions are not required . Six months after TEA , patients attain a satisfactory level of knee ROM and function Purpose . Continuous passive motion is frequently used post-operatively to increase knee range of motion after total knee arthroplasty in spite of little conclusive evidence . The aim of this study was to examine whether continuous passive motion ( CPM ) as an adjunct to active exercises had any short time effects ( after one week and three months ) on pain , range of motion , timed walking and stair climbing . Method . A r and omized controlled trial was conducted . A total of 63 patients undergoing primary TKA were r and omly assigned into an experimental group receiving CPM and active exercises and a control group receiving active exercises only . Outcomes were assessed by goniometer , visual analogue scale ( VAS ) , timed ‘ Up and Go ’ test ( TUG ) , timed 40 m walking distance and timed stair climbing . Results . There were no statistical differences between the treatment groups for any outcome measures either at one week or after three months . For the whole group , a significant and 50 % reduction in pain score was found after three months ( p < 0.01 ) . Compared with before surgery , a significantly impaired knee flexion range of motion ( p < 0.01 ) and a significantly decreased number of patients able to climb stairs were found after three months ( p < 0.01 ) . Conclusion . CPM was not found to have an additional short-time effect compared with active physiotherapy . After three months considerable pain relief was obtained for the whole group , the patients preoperative ROM was not restored and the number of patients able to climb stairs had decreased BACKGROUND AND PURPOSE This r and omized clinical trial was conducted to compare the effectiveness of 3 in-hospital rehabilitation programs with and without continuous passive motion ( CPM ) for range of motion ( ROM ) in knee flexion and knee extension , functional ability , and length of stay after primary total knee arthroplasty ( TKA ) . SUBJECTS Eighty-one subjects who underwent TKA for a diagnosis of osteoarthritis were recruited . METHODS All subjects were r and omly assigned to 1 of 3 groups immediately after TKA : a control group , which received conventional physical therapy intervention only ; experimental group 1 , which received conventional physical therapy and 35 minutes of CPM applications daily ; and experimental group 2 , which received conventional physical therapy and 2 hours of CPM applications daily . All subjects were evaluated once before TKA and at discharge . The primary outcome measure was active ROM in knee flexion at discharge . Active ROM in knee extension , Timed " Up & Go " Test results , Western Ontario and McMaster Universities Osteoarthritis Index question naire scores , and length of stay were the secondary outcome measures . RESULTS The characteristics of and outcome measurements for the subjects in the 3 groups were similar at baseline . No significant difference among the 3 groups was demonstrated in primary or secondary outcomes at discharge . DISCUSSION AND CONCLUSION The results of this study do not support the addition of CPM applications to conventional physical therapy in rehabilitation programs after primary TKA , as applied in this clinical trial , because they did not further reduce knee impairments or disability or reduce the length of the hospital stay Sixty primary total knee arthroplasties in 43 Chinese patients were included into a prospect i ve study . Twenty-six patients who had unilateral knee arthroplasty were r and omized to receive continuous passive motion ( CPM ) or immobilization in the first week . The 2 groups of patients were comparable in demographic data and preoperative knee range of motion ( ROM ) . In 17 patients who had 1-stage sequential bilateral arthroplasties , one side had CPM and the other side was immobilized . The active knee ROM was assessed regularly until 1 year after the operation . For all patients , the early active knee ROM in the CPM group was significantly better than the immobilization group . There was no difference after 7 days , however . For patients who had 1-stage bilateral total knee arthroplasties , the active knee ROM was significantly better on the CPM side until day 28 . After 4 weeks , there was no difference between the CPM group and the immobilization group . Immobilization after total knee arthroplasty does not preclude good ROM Twenty-two primary total knee arthroplasties were prospect ively r and omized into one of two treatment protocol s. Ten of these patients were managed in the hospital after surgery by means of a postoperative splint . The remaining 12 patients were placed immediately postoperatively in the recovery room into the continuous passive motion ( CPM ) device . The study compares the range of motion , analgesic use , hospital stay , and the volume of hemovac output in the two groups . These cases demonstrated two statistically significant findings with the use of CPM : ( 1 ) decreased use of narcotic analgesics and ( 2 ) decreased length of hospital stay OBJECTIVES We prospect ively evaluated the effects of continuous passive motion ( CPM ) started after two different time intervals following total knee arthroplasty ( TKA ) on short- and long-term results , in comparison with st and ard physical therapy . METHODS Eighty-six patients were r and omized to three groups following TKA for primary osteoarthritis . The control group ( n=28 ) received only conventional physical therapy . Group I and II , each consisting of 29 patients , were treated with conventional physical therapy combined with CPM that was started on the first and third postoperative days , respectively , and continued until discharge with three one-hour sessions daily . Preoperative and postoperative measurements of the knee range of motion were recorded . Clinical and functional results were assessed using the Knee Society rating system . The patients were followed-up for at least two years ( range 26 to 52 months ) . RESULTS The duration of CPM  was 22 hours in group I , and 19 hours in group II ( p>0.05 ) . Knee flexion values measured in the CPM groups on day 3 and at discharge showed significant differences with those of the control group , but no significant differences were found between the groups after the first postoperative month in this respect ( p>0.05 ) . The mean duration to reach 100 degrees of passive knee flexion ( p=0.03 ) and the mean length of hospital stay ( p=0.04 ) in the CPM groups were shorter by three and two days compared to the control group , respectively . Clinical and functional knee scores showed significant improvements in all the groups postoperatively ( p<0.001 ) , but there were no significant differences between the groups with respect to pre- and postoperative knee scores ( p>0.05 ) . CONCLUSION Even though CPM protocol s applied following TKA may shorten the length of hospital stay , CPM applications do not offer additional short- and long-term benefits over st and ard physical therapy with respect to knee flexion and clinical and functional results
The estimates for risk of manipulation and adverse events are very imprecise and the estimate for the risk of adverse events does not distinguish between a clinical ly important increase and decrease in risk .
There was insufficient evidence to determine the effect of CPM on participants ' global assessment of treatment effectiveness .
CPM does not have clinical ly important effects on active knee flexion ROM , pain , function or quality of life to justify its routine use .
BACKGROUND Arthritis of the knee is a common problem causing pain and disability .
If severe , knee arthritis can be surgically managed with a total knee arthroplasty .
Rehabilitation following knee arthroplasty often includes continuous passive motion ( CPM ) .
CPM is applied by a machine that passively and repeatedly moves the knee through a specified range of motion ( ROM ) .
It is believed that CPM increases recovery of knee ROM and has other therapeutic benefits .
However , it is not clear whether CPM is effective .
OBJECTIVES To assess the benefits and harms of CPM and st and ard postoperative care versus similar postoperative care , with or without additional knee exercises , in people with knee arthroplasty .
This review is an up date of a 2003 and 2010 version of the same review .