American Academy of Orthopaedic Surgeons

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Released May 12, 2020

Avoid routine use of Continuous Passive Motion (CPM) after knee arthroplasty.

Two high-quality studies (Beaupre 2001, Denis 2006) and five moderate quality studies (Can 2003, Chen 2013, Herbold 2014, MacDonald 2000, Montgomery 1996) compared the utilization of continuous passive motion during hospital stay to no utilization of continuous passive motion. The combined results provide strong evidence that the surgical outcomes for those who used continuous passive motion are not better than for those who did not use continuous passive motion.

Five of the seven studies measured outcomes of physical function and quality of life. Beaupre, Denis, Herbold, and MacDonald found no significant differences in a gamut of outcomes (WOMAC, SF-36, Timed “up + go” [TUG], functional independence measure [FIM], and Knee Society Score). Chen reported better quality of life in the group that did not use continuous passive motion. Knee range of motion was investigated by Beaupre, Denis, and Chen. Meta-analysis showed no differences in knee range of motion. Complications were evaluated by Beaupre and Denis and were not statistically
different between groups. Beaupra, Can, Chen, MacDonald, and Montgomery demonstrated that pain and stiffness were not decreased by CPM, whereas Denis reported significantly less pain in the continuous passive motion group (12 points difference in VAS ranging from 0–100). Meta-analysis from Denis, Herbold, and Montgomery showed no differences in length of hospital stay.

One high-quality study (Lenssen 2008) demonstrated no statistically significant benefits in functional outcome scores or range of motion with the use of continuous passive motion in conjunction with physical therapy compared to physical therapy alone. The continuous passive motion was used for 17 consecutive days after surgery (about 2 weeks after discharge).

CPM should not be used routinely for every knee arthroplasty, as there have been no differences in active knee range of motion, pain, function, or quality of life (Harvey, 2014). CPM has been used after manipulation under anesthesia performed after knee surgery, although there are no studies to support this in the arthroplasty literature (Bram, 2019).


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

(1–5) The American Academy of Orthopaedic Surgeons (AAOS) routinely develops evidence-based clinical practice guidelines as valuable tools to advance the physician-patient communications process and enhance the diagnosis and treatment of musculoskeletal conditions. AAOS physician volunteer work groups develop evidence-based clinical practice guidelines to serve as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment. The most recent approved clinical practice guidelines have been published in the Journal of Bone and Joint Surgery. AAOS staff, led by the medical director, conducted a review of the approved clinical practice guidelines previously developed by the work groups and selected a variety of topics frequently used in orthopaedic surgical practice. After input from the orthopaedic specialty society leaders and approval from the AAOS Presidential Leadership and Board of Directors, the final five topics were selected for this campaign. The AAOS disclosure and conflict of interest policy can be found at www.aaos.org.

(6-10) The American Academy of Orthopaedic Surgeons (AAOS) routinely develops evidence-based clinical practice guidelines as valuable tools to advance the physician-patient communications process and enhance the diagnosis and treatment of musculoskeletal conditions. AAOS physician volunteer workgroups develop evidence-based clinical practice guidelines to serve as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment. AAOS staff methodologists conducted a review of the approved clinical practice guidelines previously developed by the workgroups and selected a variety of topics frequently used in orthopaedic surgical practice. After input and approval from the AAOS Committee on Evidence-Based Quality and Value, followed by the approval from the AAOS, Council on Research and Quality and AAOS Board of Directors, the final five topics were selected for this campaign. The AAOS disclosure and conflict of interest policy can be found at www.aaos.org/quality.

Sources

Beaupre,L.A., Davies,D.M., Jones,C.A., Cinats,J.G. Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty. Phys.Ther. 2001; 0: 1029-1037

Bram J.T, Gambone A.J, DeFrancesco, C.J., Striano B.M, Ganley, T.J. Use of Continuous Passive Motion Reduces Rates of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in a Pediatric Population. Orthopedics. 2019/1; 42: 81-85
Can,F., Alpaslan,M. Continuous passive motion on pain management in patients with total knee arthroplasty. Pain Clinic 2003; 4: 479-485

Chen,L.H., Chen,C.H., Lin,S.Y., Chien,S.H., Su,J.Y., Huang,C.Y., Wang,H.Y., Chou,C.L., Tsai,T.Y., Cheng,Y.M., Huang,H.T. Aggressive continuous passive motion exercise does not improve knee range of motion after total knee arthroplasty. J Clin Nurs. 2013/2; 3: 389-394

Denis,M., Moffet,H., Caron,F., Ouellet,D., Paquet,J., Nolet,L. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Phys Ther 2006/2; 2: 174-185
Harvey, L.A., Brosseau, L., Herbert R.D. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2014; 6(2)

Herbold,J.A., Bonistall,K., Blackburn,M., Agolli,J., Gaston,S., Gross,C., Kuta,A., Babyar,S. Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement. Arch Phys Med Rehabil 2014/7; 7: 1240-1245

MacDonald,S.J., Bourne,R.B., Rorabeck,C.H., McCalden,R.W., Kramer,J., Vaz,M. Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty. Clin Orthop Relat Res. 2000/11; 380: 30-35

Montgomery,F., Eliasson,M. Continuous passive motion compared to active physical therapy after knee arthroplasty: similar hospitalization times in a randomized study of 68 patients. Acta Orthop Scand. 1996/2; 1: 7-9