Postoperative use of continuous passive motion, transcutaneous electrical nerve stimulation, and continuous cooling pad following total knee arthroplasty

Abstract

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 < .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 < .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. No significant difference in UTKA outcome (postoperative drain blood loss, hospitalization duration, or range of motion) was shown for any of the comparison groups.