title: Squatting Following Total Knee Arthroplasty Continuous passive motion as an adjunct to active exercises in early rehabilitation following total knee arthroplasty – a randomized controlled trial Use of continuous passive motion after total knee arthroplasty. Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients. [A comparison of kinesitherapy with and without continuous passive motion (CPM) after the entire allograft surgery of the knee]. The effect of continuous passive motion on wound-healing and joint mobility after knee arthroplasty. Beneficial effects of continuous passive motion after total condylar knee arthroplasty. Rehabilitation After Total Knee Arthroplasty: A Comparison of 2 Rehabilitation Techniques Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery. [The effects of two different continuous passive motion protocols on knee range of motion after total knee arthroplasty: a prospective analysis]. Continuous passive motion after total knee arthroplasty. Analysis of cost and benefits. A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Clinical value of regular passive ROM exercise by a physical therapist after total knee arthroplasty Continuous Passive Motion After Total Knee Arthroplasty: A Prospective Study Home continuous passive motion machine versus professional physical therapy following total knee replacement. The influence of continuous passive motion on the results of total knee arthroplasty. Continuous passive motion with accelerated flexion after total knee arthroplasty. Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty. Early knee mobilization after osteotomy for gonarthrosis. Continuous passive motion versus physical therapy in total knee arthroplasty. Continuous passive motion for osteoarthritis of the hip: a pilot study. Continuous passive motion after primary total knee arthroplasty. Does it offer any benefits? Continuous passive motion following total knee replacement: a prospective randomized trial with follow-up to 1 year Use of Inpatient Continuous Passive Motion Versus No CPM in Computer‐Assisted Total Knee Arthroplasty The use of a passive motion machine in the postoperative rehabilitation of Dupuytren's disease. No effect of continuous passive motion after arthroplasty of the knee. Continuous passive motion after total knee arthroplasty. Prospective Randomized Clinical Trial of Continuous Passive Motion After Total Knee Arthroplasty Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial.
abstract: & NA ; This prospect i ve study was performed to investigate whether postoperative alternate flexion and extension splinting ( daily change in position of immobilization by splinting ) was useful in restoring full range of motion ( ROM )  after total knee arthroplasty as compared with continuous passive motion . The  alternate flexion and extension splinting group and the  continuous passive motion group were each composed of 34 knees .  Final ROM was measured at an average of 3.5 years postoperatively . Squatting was possible in 31 knees ( 45.6 % ) of the alternate flexion and extension  splinting group . The postoperative ROM of the osteoarthritic knees ( 131.8 ° ± 12.3 ° ) was significantly greater than that of the rheumatoid knees ( 121.9 ° ± 22.4 ° ) ( p < 0.05 ) . The postoperative ROM of the alternate flexion and extension splinting group ( 135.1 ° ± 11.9 ° ) also was significantly greater than that of the continuous passive motion group ( 120.0 ° ± 19.7 ° ) ( p < 0.01 ) . There was no statistically significant relationship between the posterior slope of tibial cutting and the postoperative ROM . It is suggested that alternate flexion and extension splinting is effective in restoring full ROM after total knee arthroplasty 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 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 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 A prospect i ve r and omized single blind investigation after total knee arthroplasty was performed to evaluate two rehabilitation protocol s ( one with CPM and the other without CPM ) . A series of 87 consecutive total knee arthroplasties in 76 patients ( 72 women and 4 men ) was analyzed . The average age of the patients was 64.7 years .  Kinesitherapy with CPM was performed in 30 ( 34.5 % ) cases , where as in 57 ( 65.5 % ) cases kinesitherapy without CPM was performed . Early functional results according to the HSS scale were assessed on the 14th day after surgery . In the group treated with CPM there were 26.7 % excellent results , 70.0 % good results and 3.3 satisfactory results . The group treated without CPM there were 26.3 % excellent results , 70.2 % good results and 3.5 % satisfactory results . No statistically significant differences were noted between the results yielded by these two rehabilitation protocol A prospect i ve , controlled , r and omized trial of continuous passive motion and immobilization after knee arthroplasty revealed that continuous passive motion significantly improved early and late flexion of the knee , reduced the duration of stay in the hospital , and did not increase the incidence of superficial infection or problems with wound-healing . Flexion of the knee beyond 40 degrees progressively diminished viability of the edges of the wound , particularly the lateral edge . On the basis of these results , a protocol for continuous passive motion was design ed to minimize the detrimental effects on viability of the wound 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 This study was conducted to compare postoperative  total knee arthroplasty rehabilitation protocol s. The hypothesis of this study was that patients undergoing total knee arthroplasty could achieve range of motion and hospital discharge in the same period using a postoperative rehabilitation protocol that did not use a continuous passive motion machine . This r and omized prospect i ve study compared 46 total knee arthroplasties in which a continuous passive motion machine was used with 37 total knees that were rehabilitated with  early passive flexion of the knee ( named drop and dangle protocol ) . Postoperative physical therapy regimens were otherwise the same for both groups . Surgical technique was the same for both groups except for closure which was performed in the drop and dangle group with the knee at 90 ° to 95 ° flexion . Only patients with osteoarthritis were included in the study , and in both groups of patients received the same prosthetic components . Patients in the drop and dangle group were discharged from the hospital 1 day earlier ( p = 0.01 ) and had a statistically better extension range of 2.8 ° at 6 months ( p = 0.03 ) . Knees in the drop and dangle group had less drainage ( p = 0.06 ) . Range of motion and hospital discharge can be achieved in a similar time interval with the drop and dangle technique as with using a continuous passive motion device , and that such a device is not required for postoperative knee rehabilitation 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 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 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 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 authors report the results of a prospect i ve study examining the benefits of daily continuous passive motion combined with physical therapy , compared with physical therapy alone , in 103 consecutive osteoarthritic patients undergoing primary total knee arthroplasty . The first 51 patients received continuous passive motion initiated in the recovery room and the next 52 patients did not receive continuous passive motion . Both groups underwent an identical physical therapy protocol starting on the first postoperative day . At discharge , there was a significant increase in active flexion in the continuous passive motion group . There were no significant differences regarding pain , wound healing , knee swelling , wound drainage , pulmonary embolism , or length of hospital stay between the 2 groups . At 2 years , there were no clinical differences in the motion or knee scores . Knee  manipulation was done for < 50 degrees flexion after the tenth postoperative day . There were 5 manipulations in the noncontinuous passive motion group and none in the continuous passive motion group . The entire costs associated with the 5 manipulations was $ 48,274 or $ 937 per patient not receiving continuous passive motion . The average daily inpatient rental of the machine was $ 60 per day . Continuous passive motion is efficacious in increasing short-term flexion and decreasing the need for knee manipulation without increasing costs 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 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 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 Regular passive ROM exercise ( PROME ) by a physical therapist is often incorporated in rehabilitation protocol s after total knee arthroplasty ( TKA ) . This r and omized , controlled trial examined whether or not the incorporation of PROME to a postoperative rehabilitation protocol would offer a better clinical outcome after TKA . Fifty consecutive patients who underwent bilateral TKAs staged 2 weeks apart received PROME for one knee and not for the other . The pain level ( 7D and 14D ) , patient ’s preference ( before discharge , 6 M ) , maximum flexion ( 7D , 14D , 3 M , 6 M ) and American Knee Society and WOMAC scores ( 6 M ) were determined in the knees with and without PROME and compared . There were no significant differences in the maximum flexion , pain level , patient ’s preference , AKS scores and WOMAC scores . This study demonstrates that the incorporation of PROME does not offer additional clinical benefits to the patients after TKA . Our findings may suggest that encouraging patients to perform active ROM exercise would be a better option and that a physiotherapy session by a physical therapist can focus on more functional rehabilitation , such as preparing to return to daily activities 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 A vigorous rehabilitation program following discharge from the hospital is necessary for patients having a total knee arthroplasty to maintain and improve range of motion and function . To compare the effectiveness of the continuous passive motion ( CPM ) machine as a home therapy program versus professional physical therapy , a prospect i ve , comparative , r and omized clinical study of 103 consecutive primary total knee arthroplasties in 80 patients ( 23 bilateral ) was performed . The CPM group consisted of 37 patients ( 49 knees ) , and the physical therapy group consisted of 43 patients ( 54 knees ) . At 2 weeks , knee flexion was similar in the two groups , but a flexion contracture was noted in the CPM group ( 4.2 degrees ) . This difference is felt by the authors to be clinical ly insignificant . At 6 months , there were no differences in knee scores , knee flexion , presence of flexion contracture , or extensor lag between the two groups . The cost for the CPM machine group was $ 10,582 ( $ 286 per patient ) , and the cost for professional therapy was $ 23,994 ( $ 558 per patient ) . We conclude that the CPM machine after the hospital discharge of patients having total knee replacement is an adequate rehabilitation alternative with lower cost and with no difference in results compared with professional therapy 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 The use of continuous passive motion after total knee arthroplasty remains controversial . A new approach , starting continuous passive motion at 70 degrees to 100 degrees flexion in the recovery room ( Group I ) was evaluated . A r and omized , prospect i ve study of 210 consecutive total knee arthroplasties was performed at two institutions . The control population ( Group II ) started continuous passive motion at 0 degree to 30 degrees , and progressed toward 100 degrees flexion . Flexion at postoperative Day 3 ( Group I = 82.5 degrees , Group II = 72.8 degrees ) , and at discharge ( Group I = 89.1 degrees , Group II = 84.3 degrees ) were significantly different . There was no significant difference between the groups at 4 weeks ( Group I = 5.0 degrees-104.1 degrees , Group II = 5.6 degrees-102.0 degrees ) , 6 weeks ( Group I = 2.3 degrees-104.8 degrees , Group II = 2.7 degrees-103.6 degrees ) , 12 weeks ( Group I = 1.7 degrees-107.7 degrees , Group II = 4.7 degrees-108.2 degrees ) , or at 1 year ( Group I = 0.5 degree-113.2 degrees , Group II = 1.8 degrees-110.5 degrees ) . In Group I , wound necrosis developed in one patient that required a gastrocnemius flap . This major complication was caused by a tight dressing , and not necessarily to the accelerated flexion continuous passive motion . This investigation shows that continuous passive motion using accelerated flexion allows increased flexion during the hospital stay without increased risk of complications , pain , or blood loss . This has significant implication s for achieving safe , early discharge . However , no difference was found at followup of 4 weeks or greater , and this did not add significantly to the final outcome Three rehabilitation modalities relating to in-hospital postoperative care following unilateral total knee arthroplasty ( UTKA ) were studied regarding their effect on pain management and UTKA outcome : ( 1 ) continuous passive motion ( CPM ) ; ( 2 ) CPM with transcutaneous electrical nerve stimulation ( TENS ) ; and ( 3 ) CPM with continuous cooling pad ( CCP ) . Phase I : CPM .  Twenty-two UTKA patients were r and omized into two postoperative care groups : ( 1 ) 12 with CPM ; and ( 2 ) 10 with no CPM .  Total hospitalization pain medication consumption was significantly less for the CPM group ( P less than .05 ) . Phase II : CPM With TENS .  Forty-eight UTKA patients were r and omized into three postoperative care groups : ( 1 ) 18 with an ipsilateral thigh TENS unit delivering sensory threshold stimulation ; ( 2 ) 18 with a subthreshold TENS unit ; and ( 3 ) 12 with no TENS unit . All groups used CPM . No significant difference was found regarding pain medication consumption . Phase III : CPM With CCP .  Thirty consecutive UTKA patients were divided into two postoperative care groups : ( 1 ) 15 with a CCP unit ; and ( 2 ) 15 with no CCP unit . Both groups used CPM . No significant difference was found regarding total or intramuscular hospitalization pain medication consumption . However , oral hospitalization pain medication consumption was significantly less for the CCP group ( P less than .01 ) . This postoperative UTKA study demonstrates significantly decreased total in-hospital pain medication consumption when comparing CPM vs no CPM , significantly decreased oral in-hospital pain medication consumption when comparing CPM with CCP vs CPM without CCP , but no difference when comparing CPM with TENS vs CPM without TENS . ( ABSTRACT TRUNCATED AT 250 WORDS In a prospect i ve study , 32 knees in 32 patients were r and omized to either a cylinder plaster cast ( 17 knees ) or hinged cast-brace ( 15 knees ) after high tibial osteotomy for medial gonarthrosis . At 6 weeks , 3 months , and still 1 year after surgery , the range of motion was better in the cast-brace group . There was no difference in the other clinical results at 3 months and at 1 year after surgery , nor in changes of osseous correction or in the final knee alignment . All the patients in the cast-brace group were satisfied with early motion To determine the justification of a continuous passive motion machine in the treatment of postoperative total knee arthroplasties , a comparative study of 50 consecutive patients with simultaneous bilateral total knee arthroplasties was undertaken . The patients served as their own controls because one r and omly selected knee was placed in the machine while the remaining knee was treated with physical therapy only . There was no significant difference in the range of motion during the eight days of hospitalization or the follow-up visits at two weeks , two months , six months , and one year . There was a significant decrease in the swelling about the knee . The continuous passive motion treated knees appeared to be generally weaker as revealed by more extensor lags and flexor tightness at discharge from the hospital . Also , increased costs incurred from the need for additional equipment and increased staff time made the machine neither cost-effective nor beneficial OBJECTIVE To evaluate whether extended use of continuous passive motion ( CPM ) may allay the pain of walking , diminish disease effect , and increase the usual walking speed in patients with osteoarthritis ( OA ) of the hip . METHODS This pilot study comprised 21 patients with Kellgren-Lawrence grade 2 - 4 OA of the hip who used CPM for periods of 1.2 to 7.6 h daily throughout a 12 week trial . RESULTS Significant improvements were found in the patients ' assessment of pain on visual analog scale , Sickness Impact Profile , self-selected walking speed , and the number of subjects who decreased their medication usage . None of these improvements was related to the radiographic grade of the patients ' OA or the daily duration of CPM . CONCLUSION Although regular exercise is now routinely recommended to patients with OA , there has been relatively little study of specific exercise programs . As such investigations are undertaken , we believe CPM should be included among the options that are studied We report a prospect i ve r and omly controlled trial to examine the effectiveness of continuous passive motion ( CPM ) in improving postoperative function and range of movement  after total knee arthroplasty ( TKA ) . We allocated 53 patients ( 57 knees ) to one of three postoperative regimes : no CPM ( n = 19 ) ; CPM at 0 to 40 degrees ( 0 to 40 CPM ; n = 18 ) ; and CPM at 0 to 70 degrees ( 0 to 70 CPM ; n = 20 ) . Those in the CPM groups had CPM for 48 hours and all patients had an identical regime of physiotherapy . There was an even distribution of various cemented and cementless TKAs in each group . Patients were assessed preoperatively and at one week and at one year postoperatively . At one week , there was a statistically significant increase in the range of flexion and total range of movement in the 0 to 70 CPM group compared with the no-CPM group . At one year we found no significant differences in mean flexion , overall range of movement , fixed flexion deformity or functional results in the three groups . Those who had CPM had a significant increase in analgesic requirement ( p = 0.04 ) . There was an increased mean blood drainage postoperatively in those who had 0 to 70 CPM ( 1558 ml ) compared with those with no CPM ( 956 ml ) ( t = 2.96 , p = 0.005 ) and with 0 to 40 CPM ( 1017 ml ) ( t = 2.62 , p = 0.01 ) . Our findings show that CPM had no significant advantage in terms of improving function or range of movement , and that its use increased blood loss and analgesic requirements We have carried out a prospect i ve r and omised , single blind clinical trial to investigate the effect of continuous passive motion on range of knee flexion , lack of extension , pain levels and analgesic use after total knee replacement surgery . 85 subjects were r and omly allocated to control or study group . All subjects followed the existing rehabilitation protocol , which permits immediate active range of motion exercises and mobilisation with the study group using continuous passive motion for 1 h , twice a day . Outcome measures employed were range of motion , pain assessed on a visual analogue scale and analgesic use according to the WHO ladder . Blinded evaluation was carried out preoperatively , at time of discharge from hospital , 6 weeks , 6 and 12 months postoperation . No significant difference was observed between groups at all time intervals for each outcome variable using Wilcoxon Rank sum tests . The results substantiate previous findings that short duration continuous passive motion following total knee arthroplasty does not influence outcome of range of motion or reported pain 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 The purpose of this study was to prospect ively compare the postoperative use of passive motion ( PM ) and st and ard h and therapy after surgical treatment of Dupuytren 's disease for extent and rate of recovery of joint motion . Our data indicate that metacarpophalangeal joint contractures improved completely to a mean of 0 degrees , regardless of the postoperative protocol . Contractures at the proximal interphalangeal joint showed incomplete recovery in both study groups , with a mean residual contracture of 28 degrees for PM patients and 38 degrees for control patients . Contractures of the metacarpophalangeal-proximal interphalangeal joints in the same finger showed complete metacarpophalangeal joint recovery to a mean of 0 degrees but incomplete proximal interphalangeal joint recovery with a mean residual contracture of 30 degrees in PM patients and 22 degrees in control patients . We conclude that the use of a PM machine in the rehabilitation of Dupuytren 's disease does not offer an advantage in the postoperative management of this condition We r and omly allocated 54 patients to active physical therapy only or this combined with 2 hours of passive knee motion twice daily from 2 - 12 days after total knee arthroplasty .  The range of knee motion was measured on the 14th postoperative day . We found no difference between the groups . We concluded that 4 hours ' passive motion daily in addition to early , active physical therapy does not improve the range of knee motion or promote mobilization after arthroplasty 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 The authors report the results of a prospect i ve r and omized clinical trial using continuous passive motion after total knee arthroplasty . One hundred twenty patients were assigned r and omly to one treatment group : No continuous passive motion ( Group I ) , continuous passive motion from 0 ° to 50 ° and increased as tolerated ( Group II ) , and continuous passive motion from 70 ° to 110 ° ( Group III ) . The continuous passive motion was initiated in the recovery room and was maintained for a maximum of 24 hours at which point all patients began identical postoperative physiotherapy regimens . Patients were assessed preoperatively , during their hospital stay , at 6 weeks , 12 weeks , 26 weeks , and 52 weeks after their surgery . There were no statistical differences between any of the treatment groups regarding cumulative analgesic requirements , range of motion at any measured interval , length of stay ( Group I , 5.1 days ; Group II , 5.2 days ; Group III , 5 days ) or Knee Society scores . The current study does not support the use of short-term continuous passive motion after total knee replacement . A st and ard and a high flexion continuous passive motion protocol failed to show any advantage over physiotherapy alone in the parameters evaluated 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
target: 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: 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 .