Abstract
BackgroundThe postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA).MethodsA prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n = 30) and control group (n = 30). The intervention group applied programed cryotherapy and CPM within 1 h while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare the numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4.ResultsThere was no significant difference in the NRS score between the groups (p = 0.168). The intervention group had significantly higher ROM than the control group (98° vs. 91°, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups (p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm).ConclusionsImmediate programmed cryotherapy and continuous passive motion could help to improve ROM quickly after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA.Trial registrationClinicalTrials.gov, NCT04136431. Registered 23 October 2019—retrospectively registered
Highlights
The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-Total knee arthroplasty (TKA))
The postoperative pain sensation after TKA can be controlled by oral/intravenous drugs combined with a peripheral nerve block (PNB) [5], local infiltration analgesia [6], or spinal anesthetic [7], the unexpected pain sensation and extremity swelling inhibit patients’ motivation for early mobilization, which results in prolonged hospital stays, delayed functional recovery, and negative psychological responses
There was no significant difference in the numeric rating scale (NRS) score between groups (p = 0.168)
Summary
The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA). Stiffness is affected by other factors after TKA, like early mobilization of the knee [9], implant position [10], rotational alignment [11, 12], size of the implant, overloading of some compartments [13], and previous range of motion (ROM) [14]. Adequate pain management and control of localized swelling and stiffness after TKA has become a priority because it is essential for improving patient satisfaction, prevention of complications, and enhancing quality of life by faster recovery. The current fast-track TKA apply proper pain management, avoid long PNB, and give physiotherapy instructions to start active motion as soon as possible [15]. The patient must be warned about the adverse effects of opioid drugs prescribed and should be taught to control these side effects to avoid the delay of the rehabilitation program [16]
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