Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty. A randomized, controlled trial comparing compression bandaging and cold therapy in postoperative total knee replacement surgery. Continuous-flow cold therapy after total knee arthroplasty. [Cryotherapy as analgesic technique in direct, postoperative treatment following elective joint replacement]. The role of cold compression dressings in the postoperative treatment of total knee arthroplasty. Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. The effect of cold therapy on the postoperative course of total hip and knee arthroplasty patients. Cryotherapy for postoperative pain relief following knee arthroplasty. Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. The use of cold compression dressings after total knee replacement: a randomized controlled trial. Cryotherapy temperature differences after total knee arthroplasty: a prospective randomized trial. Cold compressive dressing after total knee arthroplasty.
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 randomized 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 randomized 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) To examine the difference between compression bandaging and cold therapy after total knee arthroplasty.
                Eighty-four postoperative, unilateral, total knee replacement, surgical clients.
                Clients were randomized into two groups: those receiving compression bandaging, and those receiving cryo-pad technology. Subjects were assessed for total length of stay, blood loss, blood transfusion, swelling, flexion, pain, and opiate use.
                Unlike other studies, the results of these data showed no significant differences between groups on the measured outcomes. A simple cost benefit analysis shows that the compression bandage is cheaper and more labor efficient than the cold therapy as delivered by cryo-pad technology. Cryotherapy is widely used as an emergency treatment of sports trauma and postoperatively especially after anterior cruciate ligament reconstruction. Studies in the literature on the effect of cryotherapy after total knee arthroplasty (TKA) have been limited and controversial. In this prospective study, 60 primary TKAs were done on 30 patients (all staged bilateral TKAs). For every patient, 1 TKA had a continuous-flow cooling device applied over the surgical dressing immediately postoperatively. The other TKA in the same patient (control TKA) was done 6 weeks later and had no cooling device. The study compared the range of motion, the volume of hemovac output and blood loss, visual analog pain score, analgesic consumption, and wound healing in the 2 limbs of the same patient. This study showed that continuous-flow cold therapy is advantageous after TKA because it provides better results in all the areas compared.
                Copyright 2002, Elsevier Science (USA). The application of crushed ice or hydrogenated silicate, a micro-crystalline substitute has been used as a method to treat posttraumatic and postoperative irritations of the locomotor system for a long time. Closed systems using pumps can be viewed as further development as they enable continuous, water-free cooling of operating areas. The analgetic effect of postoperative cold therapy was evaluated in a prospective clinical trial, including 312 patients after total knee or hip arthroplasty. Conventional cold packs, consisting of microcrystalline silicate were compared to a continuous applicable closed system. Continuous cryotherapy resulted in a depression of skin temperature to 12 degrees C, whereas intermittent cooling only caused a mean temperature decrease of 1 degree C. Clinically continuous cold application leads to a more than 50% decrease of analgetic demands in both, systemic and regional application (p < 0.001). This observation was found in a significant correlation with patient's pain sensation as well as primary range of motion. Intermittent cryotherapy was found to be ineffective in postoperative pain relieve in hip- and adequate in knee arthroplasty patients. We could not report an influence on postoperative blood loss, as discussed in previous reports. A prospective randomized study was performed to evaluate the role of cold compressive dressings in the postoperative treatment of total knee arthroplasty (TKA). Eighty consecutive unilateral and ten bilateral primary total knee replacements were evaluated in terms of blood loss, pain relief, and range of motion. Patients in the cold compression group demonstrated an average of 548 ml in suction drainage, whereas those in the control group averaged 807 ml. This resulted in an average 3.1 mg hemoglobin drop in the cold compression group and 4.7 mg in the control group. When body habitus and weight were taken into account in the cold compression group, an average total blood loss of 1298 cc was calculated, with 744 ml arising from soft tissue extravasation. The corresponding total blood loss calculated average was 1908 ml in the control group, with 1101 ml attributed to soft tissue extravasation. Total injectable morphine per kilogram per initial 48 hours averaged 0.53 mg in the cold compression patients and 0.69 mg in the control patients. In the cold compression knees, range of motion averaged 86 degrees before operation, 53 degrees on postoperative day (POD) 7, and 77 degrees on POD 14. In the control knees, range of motion averaged 88 degrees before operation, 44 degrees on POD 7, and 65 degrees on POD 14. The use of cold compression in the postoperative period of TKA results in a dramatic decrease in blood loss. In addition, mild improvements are seen in early return of motion and injectable narcotic pain needs in the postoperative period. Sixty patients undergoing total knee replacement were randomized to receive either a cold compression dressing (Cryo/Cuff, Aircast, UK) or a modified Robert Jones bandage immediately after surgery. The cold compression dressing was used for a minimum of 6 h per day throughout the hospital stay, and the modified Robert Jones bandage remained in place for 48 h from the time of operation. The 2 groups of patients were compared during their hospital stay for blood loss, range of movement, pain scores and need for analgesia. No difference was found between the 2 groups except for less blood loss in the surgical drains in the cold compression group (P < 0.05). Postoperative complications were seen in both groups, but no complication was associated with either the cold compression dressing or the modified Robert Jones bandage. Fifty total hip arthroplasty (THA) patients and 24 total knee arthroplasty (TKA) patients were randomized in a controlled study to examine the effects of cold therapy (via thermal blankets) in the postoperative period. The postoperative hospital stay was significantly shorter for the cold-therapy (50 degrees F) compared with control (70 degrees F) groups (by 1.4 days, P = 0.03) for THA patients. There was a similar but nonsignificant trend observed in the TKA groups (1.5 days shorter, P = 0.19). Total knee arthroplasty patients using cold therapy achieved independent ambulation an average of 1 day sooner than TKA control patients, but this difference did not reach statistical significance (P = 0.08). There were no statistically significant differences between the control groups or the test groups for both THA and TKA patients in narcotic usage, postoperative range-of-motion (ROM), or rate of progression of ROM. Ninety consecutive patients undergoing primary knee arthroplasty received local cryotherapy 72 hours after surgery for pain relief. Thermal-pad circulating temperatures were randomly assigned to 50 degrees, 60 degrees, or 70 degrees F (room temperature). Pain relief was monitored using patient-controlled analgesia machines. The amount of morphine received and number of attempts per hour were statistically analyzed with relation to temperature group, age, sex, weight, side, and diagnosis. The amount of morphine injected was positively correlated to the number of attempts per hour and moderately correlated to body weight. There was no correlation between thermal-pad temperature or any other parameter and the amount of morphine injected after surgery. A study of 86 patients undergoing total knee arthroplasty (TKA) was performed to evaluate the role of cold compression. The patients were treated with cold compression or epidural analgesia for 3 days after TKA. Pain was measured on a visual analog scale, and total consumption of analgesics was recorded. Range of movement (ROM) was recorded before TKA until 3 weeks postoperatively. Weight bearing, blood loss, and time in hospital were recorded. Visual analog scale scores and analgesic consumption were equal in both groups. Range of movement at discharge was 75 degrees in the cold compression group vs 63 degrees in the control group. By 3 weeks' follow-up, ROM was 99 degrees vs 88 degrees. Mean Hb values averaged 120 mmol/L in the cold compression group vs 109 mmol/L in the control group after surgery. Mean time in hospital of patients with cold compression averaged 4.8 days vs 6.2 days in the control group. The study shows that cold compression therapy improves the control of pain and might thus lead to improvement in ROM and shorter hospital stay. This prospective, controlled study compared cold compressive dressings with wool and crepe in the postoperative management of patients undergoing total knee replacement (TKR). Forty TKR patients were assessed for blood loss, pain, swelling, and range of motion. Patients in the cold compression group had less blood loss through suction drainage (982 mL versus 768 mL). A higher proportion of patients in the treatment group did not require blood transfusion postoperatively. Mean opiate requirements were lower in the cold compression group (0.57 versus 0.71 mg/kg/48 hours). The cold compression device appeared to reduce blood loss and pain following TKR. In spite of its widespread use after orthopaedic procedures, the literature evaluating the clinical efficacy of cryotherapy is controversial. The purpose of this prospective randomized trial was to compare two different temperatures for administering cryotherapy after total knee arthroplasty with regards to short-term postoperative outcomes. Sixty-four subjects were assigned either the 45 degrees F group or the 75 degrees F group. Subjects in the 45 degrees group were as likely to report a lower pain score at the time of follow-up compared to the 75 degrees group. Our results demonstrate no additional analgesic effect associated with the lower temperature of cryotherapy. Postoperative narcotic consumption, postoperative drainage, self-reported knee function, and range of motion were not affected by the different cryotherapy temperatures. No adverse effects were reported with the cryotherapy treatment. The efficacy of a cold compressive dressing after total knee arthroplasty (TKA) was prospectively studied in 105 knees in 76 patients. All components were cemented. All patients were placed in continuous passive motion machines after operation. A cold compressive Cryocuff dressing was applied to 50 knees after operation. An ACE wrap and ice pack were applied to the knees of 55 control patients after operation. Postoperative range of motion was recorded as maximum active flexion at two to four days (interval one), at seven to 14 days (interval two), and four to six weeks (interval three). Swelling was measured at the same time intervals by circumference at the midpatella and circumference at the distal thigh one inch proximal to the superior pole of the patella. Use of postoperative narcotics was calculated for postoperative days zero to three and for postoperative days four to seven. Wound drainage was recorded for all knees. The use of a cold compressive dressing after TKA was not associated with an increase in range of motion at any point after the operation. The Cryocuff dressing did not appreciably reduce swelling around the knee after TKA. No significant difference was found in the amount of postoperative wound drainage between the two groups of patients. In patients undergoing unilateral TKA, no significant difference existed between the narcotic requirements of control patients and patients wearing the cold compressive dressing.
Potential benefits of cryotherapy on blood loss, postoperative pain, and range of motion may be too small to justify its use, and the quality of the evidence was very low or low for all main outcomes. This needs to be balanced against potential inconveniences and expenses of using cryotherapy. Well designed randomised trials are required to improve the quality of the evidence.