Monday, March 9, 2009

CPM use after TKR- just or unjust?

The usefulness of continuous passive motion after total knee arthroplasty remains controversial.

The reported benefits include:

1. Decreased rates of knee manipulation,
2. Decreased rates of deep vein thrombosis,
3. Decreased rates of postoperative use of analgesics,
4. Greater range of motion.

The reported disadvantages include:

Many studies have reported
1. Increased wound complications, bleeding, and pain.

Confusion & debate on use of CPM:
Lack of consensus on the use of continuous passive motion exists because reported studies include many confusing variables.

Advocating for use of CPM:

1. Several studies have shown that continuous passive motion in the hospital decreased the rate of knee manipulation from as high as 21% to as low as 0%. However, many studies show that range of motion may improve more rapidly with continuous passive motion but the ultimate range of motion at follow-up is unchanged.

2. Continuous passive motion is used three times per day (1 hour sessions), beginning on the first postoperative day, within a 4 to 5 day inpatient hospital pathway. Lachiewicz PF in his center found of 132 knees that had a primary posterior-stabilized total knee arthroplasty, 7 (5%) had a manipulation for failure to obtain greater than 70 degrees flexion. No patients had major wound complications that required re-operation. There is no specific charge to the patient for the continuous passive motion because it is included in the hospital per diem charge.

3. According to Lachiewicz PF there is literature support of the use of continuous passive motion to decrease the rate of manipulation (and its costs) for poor range of motion after total knee arthroplasty.

4. If patients follow fixed inpatient hospital pathways, the length (and possibly cost) of hospital stay is not changed by use of continuous passive motion.

5. The data on the effect of continuous passive motion on overall analgesic use and prevalence of deep vein thrombosis are not clear.

Lachiewicz PF; Clin Orthop Relat Res. 2000 Nov;(380):144-50.

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