American Physical Therapy Association
View all recommendations from this societyReleased September 15, 2014
Don’t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement.
Continuous passive motion (CPM) treatment does not lead to clinically important effects on short- or long-term knee extension, long-term knee flexion, long-term function, pain and quality of life in patients undergoing total knee arthroplasty (TKA). With rehabilitation protocols now supporting early mobilization, the use of CPM following uncomplicated total knee arthroplasty should be questioned unless medical and/or surgical complication exist that limit or contraindicate rehabilitation protocols that foster early mobilization. The cost, inconvenience and risk of prolonged bed rest with CPM should be weighed carefully against its limited benefit. As members of interprofessional teams involved in post-operative rehabilitation of patient following total knee replacement, physical therapists have a responsibility to advocate for effective alternatives to CPM for most patients.
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 health care provider.
How The List Was Created
The American Physical Therapy Association (APTA) invited all 88,000 members to suggest items for the Choosing Wisely® list. Communication of this request was distributed to members via website posting, e-mail blast and social media. APTA convened an expert workgroup of physical therapists representing a broad range of clinical expertise, practice settings and patient populations. A modified Delphi technique was used to rank and prioritize the recommendations based upon the Choosing Wisely criteria. An extensive literature search was conducted on the highest rated strategies. The expert panel reviewed the literature and provided a ranking of recommendations based upon the established criteria. The final list of five strategies was selected through a survey open to all APTA members who were asked to select five items from a list of nine, all of which met the established criteria. The final list was presented to the APTA Board of Directors for final approval.
APTA’s disclosure and conflict of interest policy can be found at www.apta.org.
Sources
Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, Pelland L, Noel MJ, Davis J, Drouin H. Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. J Rheumatol. 2004;31(11):2251–64.
Grella RJ. Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation? Phys Ther Rev. 2008;13(4):269–79.
Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. 2014;2:CD004260.
van Dijk H, Elvers J, Oostendorp R. Effect of continuous passive motion after total knee arthroplasty: a systematic review. Physiother Singapore. 2007;10(4):9–19.
Viswanathan P,Kidd M. Effect of continuous passive motion following total kne e arthroplasty on knee range of motion and function: a systemat ic review. NZ J Physiother. 2010;38(1):14–22.
