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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 10/2009

01-10-2009 | Original Article

Actual Knee Motion during Continuous Passive Motion Protocols is Less Than Expected

Authors: Jesse E. Bible, BS, Andrew K. Simpson, MD, MHS, Debdut Biswas, BA, Richard R. Pelker, MD, PhD, Jonathan N. Grauer, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 10/2009

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Abstract

Investigations of the usefulness of continuous passive motion (CPM) after TKA have yielded mixed results, with evidence suggesting its efficacy is contingent on the presence of larger motion arcs. Surprisingly, the range of motion (ROM) the knee actually experiences while in a CPM machine has not been elucidated. In this study, the ability of a CPM apparatus to bring about a desired knee ROM was assessed with an electrogoniometer. The knee experienced only 68% to 76% of the programmed CPM arc, with the higher percentages generated by elevating the head of the patient’s bed. This disparity between true knee motion and CPM should be accounted for when designing CPM protocols for patients or investigations evaluating efficacy of CPM.
Literature
1.
Breen TF, Gelberman RH, Ackerman GN. Elbow flexion contractures: treatment by anterior release and continuous passive motion. J Hand Surg Br. 1988;13:286–287.PubMedCrossRef
2.
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;31:2251–2264.PubMed
3.
Chiarello CM, Gundersen L, O’Halloran T. The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. J Orthop Sports Phys Ther. 1997;25:119–127.PubMed
4.
Colwell CW Jr, Morris BA. The influence of continuous passive motion on the results of total knee arthroplasty. Clin Orthop Relat Res. 1992;276:225–228.PubMed
5.
Favreau JC, Laurin CA. Joint effusions and flexion deformities. Can Med Assoc J. 1963;88:575–576.PubMed
6.
Funk DA, Noyes FR, Grood ES, Hoffman SD. Effect of flexion angle on the pressure-volume of the human knee. Arthroscopy. 1991;7:86–90.PubMedCrossRef
7.
Harms M, Engstrom B. Continuous passive motion as an adjunct to treatment in the physiotherapy management of the total knee arthroplasty patient. Physiotherapy. 1991;7:301–307.
8.
Jayson MI, Dixon AS. Intra-articular pressure in rheumatoid arthritis of the knee. 3. Pressure changes during joint use. Ann Rheum Dis. 1970;29:401–408.PubMedCrossRef
9.
Jordan LR, Siegel JL, Olivo JL. Early flexion routine: an alternative method of continuous passive motion. Clin Orthop Relat Res. 1995;315:231–233.PubMed
10.
Levick JR. The influence of hydrostatic pressure on trans-synovial fluid movement and on capsular expansion in the rabbit knee. J Physiol. 1979;289:69–82.PubMed
11.
Maloney WJ, Schurman DJ, Hangen D, Goodman SB, Edworthy S, Bloch DA. The influence of continuous passive motion on outcome in total knee arthroplasty. Clin Orthop Relat Res. 1990;256:162–168.PubMed
12.
McInnes J, Larson MG, Daltroy LH, Brown T, Fossel AH, Eaton HM, Shulman-Kirwan B, Steindorf S, Poss R, Liang MH. A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. JAMA. 1992;268:1423–1428.PubMedCrossRef
13.
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;67:7–9.PubMed
14.
Myles CM, Rowe PJ, Nutton RW, Burnett R. The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry. Clin Biomech (Bristol, Avon). 2006;21:733–739.CrossRef
15.
Myles CM, Rowe PJ, Walker CR, Nutton RW. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry. Gait Posture. 2002;16:46–54.PubMedCrossRef
16.
Nutton RW, van der Linden ML, Rowe PJ, Gaston P, Wade FA. A prospective randomised double-blind study of functional outcome and range of flexion following total knee replacement with the NexGen standard and high flexion components. J Bone Joint Surg Br. 2008;90:37–42.PubMedCrossRef
17.
O’Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000;37:179–188.PubMed
18.
O’Driscoll SW, Kumar A, Salter RB. The effect of continuous passive motion on the clearance of a hemarthrosis from a synovial joint: an experimental investigation in the rabbit. Clin Orthop Relat Res. 1983;176:305–311.PubMed
19.
O’Driscoll SW, Kumar A, Salter RB. The effect of the volume of effusion, joint position and continuous passive motion on intraarticular pressure in the rabbit knee. J Rheumatol. 1983;10:360–363.PubMed
20.
Pope RO, Corcoran S, McCaul K, Howie DW. Continuous passive motion after primary total knee arthroplasty: does it offer any benefits? J Bone Joint Surg Br. 1997;79:914–917.PubMedCrossRef
21.
Ritter MA, Gandolf VS, Holston KS. Continuous passive motion versus physical therapy in total knee arthroplasty. Clin Orthop Relat Res. 1989;244:239–243.PubMed
22.
Romness DW, Rand JA. The role of continuous passive motion following total knee arthroplasty. Clin Orthop Relat Res. 1988;226:34–37.PubMed
23.
Rowe PJ, Myles CM, Hillmann SJ, Hazlewood ME. Validation of flexible electrogoniometry as a measure of joint kinematics. Physiotherapy. 2001;87:479–488.CrossRef
24.
Rowe PJ, Myles CM, Walker C, Nutton R. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life? Gait Posture. 2000;12:143–155.PubMedCrossRef
25.
Salter RB. Motion vs. rest: why immobilize joints? J bone Joint Surg Br. 1982;64:251–254.
26.
Salter RB, Field P. The effects of continuous compression on living articular cartilage: an experimental investigation. J Bone Joint Surg Am. 1960;42:31–49.
27.
Salter RB, Hamilton HW, Wedge JH, Tile M, Torode IP, O’Driscoll SW, Murnaghan JJ, Saringer JH. Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. J Orthop Res. 1984;1:325–342.PubMedCrossRef
28.
Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage: an experimental investigation in the rabbit. J Bone Joint Surg Am. 1980;62:1232–1251.PubMed
29.
van der Linden ML, Rowe PJ, Myles CM, Burnett R, Nutton RW. Knee kinematics in functional activities seven years after total knee arthroplasty. Clin Biomech (Bristol, Avon). 2007;22:537–542.CrossRef
30.
Ververeli PA, Sutton DC, Hearn SL, Booth RE Jr, Hozack WJ, Rothman RR. Continuous passive motion after total knee arthroplasty: analysis of cost and benefits. Clin Orthop Relat Res. 1995;321:208–215.PubMed
31.
Vince KG, Kelly MA, Beck J, Insall JN. Continuous passive motion after total knee arthroplasty. J Arthroplasty. 1987;2:281–284.PubMedCrossRef
32.
Walker CR, Myles C, Nutton R, Rowe P. Movement of the knee in osteoarthritis: the use of electrogoniometry to assess function. J Bone Joint Surg Br. 2001;83:195–198.PubMedCrossRef
Metadata
Title
Actual Knee Motion during Continuous Passive Motion Protocols is Less Than Expected
Authors
Jesse E. Bible, BS
Andrew K. Simpson, MD, MHS
Debdut Biswas, BA
Richard R. Pelker, MD, PhD
Jonathan N. Grauer, MD
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 10/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-009-0766-1

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