Continuous Passive Motion Machine Research Articles

Heterotopic ossification after total knee arthroplasty

Heterotopic ossification (HO) is a rare complication following total knee arthroplasty (TKA). In the case report presented, a 52-year-old man who had previously undergone TKA for osteoarthritis noticed painful limitation of range of motion (ROM) in spite of active participation in physical therapy and the use of a continuous passive motion machine. A plain radiograph 1 month after surgery revealed HO anterior to the distal femoral shaft in the quadriceps expansion. Ambulation for this patient was limited to short distances because of severe pain and limitation in ROM. The patient underwent manipulation under general anesthesia 2 months after the TKA. Range of motion in flexion improved from 50 degrees to 110 degrees, and the patient became ambulatory without assistive devices. However, the flexion range deteriorated to 50 degrees over a period of 4 months, and ambulation again became significantly limited. The patient underwent resection of HO 6 months after manipulation and regained his ROM to 110 degrees in flexion. He was prescribed indomethacin after surgery for 2 months to prevent recurrence of HO. Follow-up radiographs 3 months after surgery revealed minimal recurrence of HO. The patient's ROM did not deteriorate, and he remained ambulatory. Heterotopic ossification should be suspected in post-TKA patients if ROM does not improve. Physical therapy including ROM exercises remains an essential component in the treatment of HO. Manipulation under general anesthesia or surgical resection of HO may be inevitable in certain patients whose ambulation is significantly limited.

THE THERAPIST'S MANAGEMENT OF INTRA-ARTICULAR FRACTURES

Fabrication of the dynamic traction splint is described in step-by-step fashion in order to aid surgeons to understand the principles of application of the method and to assist hand therapists to make the splint. The new 6-inch diameter arcuate hoop and the radial or ulnar gutter base splint are detailed. Modification of continuous passive motion machines is described for use in conjunction with dynamic traction. Alternative splint applications and post-dynamic traction splinting therapy methods are outlined.

Cold Compressive Dressing After Total Knee Arthroplasty

The efficacy of a cold compressive dressing after total knee arthroplasty (TKA) was prospectively studied in 105 knees in 76 patients. All components were cemented. All patients were placed in continuous passive motion machines after operation. A cold compressive Cryocuff dressing was applied to 50 knees after operation. An ACE wrap and ice pack were applied to the knees of 55 control patients after operation. Postoperative range of motion was recorded as maximum active flexion at two to four days (interval one), at seven to 14 days (interval two), and four to six weeks (interval three). Swelling was measured at the same time intervals by circumference at the midpatella and circumference at the distal thigh one inch proximal to the superior pole of the patella. Use of postoperative narcotics was calculated for postoperative days zero to three and for postoperative days four to seven. Wound drainage was recorded for all knees. The use of a cold compressive dressing after TKA was not associated with an increase in range of motion at any point after the operation. The Cryocuff dressing did not appreciably reduce swelling around the knee after TKA. No significant difference was found in the amount of postoperative wound drainage between the two groups of patients. In patients undergoing unilateral TKA, no significant difference existed between the narcotic requirements of control patients and patients wearing the cold compressive dressing.

Continuous passive motion in hand rehabilitation

This paper reviews the literature comparing the results obtained in applying regimes involving motion with those involving rest following injury or surgery. The deleterious effects of immobilisation are compared to those obtained under conditions of passive motion and intermittent passive motion. It is concluded that continuous passive motion (CPM) represents an improvement on intermittent motion. Models of CPM machines are described and some results presented. It is proposed that "intelligent" CPM would represent a further improvement in technique and a prototype machine for this purpose and some preliminary results are described.

膝前十字靭帯再建術後の後療法について

Rehabilitation of the postoperative knee following anterior cruciate ligament (ACL) reconstruction has evolved and improved significantly over the past decade. We experienced two different methods of rehabilitation, and compared the post-operative course following each method.Twenty-seven patients who underwent ACL reconstruction at our institute without other ligamentous injuries were used for this study. We divided these patients into two groups dependant upon postoperative rehabilitation, (fixation group: 10, early motion group: 18). In the fixation group, the knee was immobilized for 2 weeks postoperatively. In the early motion group, a continuous passive motion machine was used after 3 days immobilization.In the early motion group, the angle of knee extension was significantly different from that in the fixation group (p. 0.4 and 8 week. p<0.05). Lachman test was negative in all cases.Early motion rehabilition following ACL reconstruction was considered to be useful and safe.

The effects of frequency and duration of controlled passive mobilization on tendon healing

This study was designed to determine the effects of frequency and duration of controlled passive motion on the healing flexor tendon following primary repair. Adult mongrel dogs were divided into two groups based on frequency of controlled passive motion. In one group, motion was applied manually at a frequency of 12 cycles/min for 5 min/day; in the other group, a continuous passive motion machine was used to apply motion at a lower frequency of 1 cycle/min for 60 min/day, making the number of cycles each day for both groups identical. Gliding function and tensile properties of repaired tendons were evaluated biomechanically at 3 and 6 weeks postoperatively. Results showed that gliding function in both groups was similar, but tensile properties, as represented by linear slope, ultimate load, and energy absorption, were significantly improved in the higher frequency group. It was concluded that frequency of controlled passive motion rehabilitation is a significant factor in accelerating the healing response following tendon repair, and higher frequency-controlled passive motion has a beneficial effect.

Basic Science AND Pathology

Management of intraarticular fractures is often complicated by joint stiffness long after bony healing has occurred. The following experiments provide biomechanical evidence for the effectiveness of CPM in maintaining joint function in stabilized articular injuries. The ankles of ten adolescent New Zealand white rabbits were penetrated by Steinmann pins to create an intraarticular injury. One limb of each animal was immobilized, and the contralateral limb was placed in a continuous passive motion (CPM) machine for three weeks. Joint stiffness of each ankle was quantified with an arthrograph before injury and after three weeks of treatment. Hindlimb volumes were recorded before injury and monitored at weekly intervals using a water-displacement method. Joint stiffness increased 2.6 times the preinjury levels in limbs that were immobilized for three weeks. There was no statistically significant increase in joint stiffness in ankles treated with CPM compared to preinjury values. The posttraumatic difference between the CPM-treated and immobilized limbs was highly significant; limb swelling was not affected by CPM.

Shoulder rheumatoid arthritis associated with chondromatosis, treated by arthroscopy

We present a case of rheumatoid arthritis that affected the right shoulder and was associated with chondromatosis and multiple loose body formation. The arthritis was treated arthroscopically with satisfactory results after a follow-up period of 15 months. In our case, arthroscopic debridement and partial synovectomy not only relieved the pain but also improved the range of motion the night after surgery. The multiple loose bodies irritating the synovium and causing effusion, crepitus, and locking were also removed. One may need to change portals of the scope and suction cannula to remove loose bodies in different joint spaces. The subacromial space must be searched for loose bodies. Thorough cleaning, lavage, and synovectomy are important parts of this surgery. The continuous passive motion (CPM) machine in the immediate postoperative period was helpful.

Continuous Passive Motion as an Adjunct to Treatment in the Physiotherapy Management of the Total Knee Arthroplasty Patient

<h2>Summary</h2> Over the past decade continuous passive motion (CPM) has found increasing popularity in the management of patients undergoing total knee arthroplasty (TKA). However, the literature contains many controversies about the advantages of CPM and although it has been shown to have some value, there has been no conclusive work on its most beneficial mode of use. The objective of this study was to determine whether patients undergoing TKA benefit from having CPM incorporated into their conventional physiotherapy regime (in terms of speed and quality of recovery) and to establish whether further resource allocation was justified. Pre-operatively 113 TKA patients were randomly allocated to one of two groups, in a prospective study. Both groups performed a standardised exercise programme and one group also spent six hours each day on a CPM machine. The results showed that CPM significantly improved knee range-of movement following surgery and patients found it easier to regain their movement. Patients who had CPM recorded lower pain levels and spent less –time in hospital, with fewer requiring out-patient physiotherapy. However, these latter results did not reach statistical significance. CPM did not increase the patient's analgesic requirements or wound drainage and neither did it increase the incidence of complications. The groups of patients who appeared to gain the most benefit are identified and an optimum CPM regime is recommended. CPM has a value in the treatment of patients following TKA and apart from the initial cost of the machines, there is little increase in resource requirements when CPM is used as an adjunct to treatment.

Value of Continuous Passive Motion in Total Knee Arthroplasty

Two methods of rehabilitation after 91 total knee arthroplasties in 74 patients were reviewed. Patients in each group were well matched for age, sex, and diagnosis. Forty-four knees in 39 patients were treated with conventional physiotherapy, consisting of 3 days of immobilization followed by a program of active assisted range-of-motion exercises. Forty-seven knees in 41 patients were placed in a continuous passive motion machine immediately after operation. Other aspects of preoperative, intraoperative, and postoperative care were identical in both groups. Patients in the continuous passive motion group were found to have a lower incidence of complications, especially of wound healing problems and thromboembolic disease. Analgesic use in patients in the continuous passive motion group was reduced. Straight leg raising was achieved slightly earlier in patients in the continuous passive motion group (4.9 days) compared with patients not treated with continuous passive motion (5.2 days). Although the range of motion of the knee at discharge from the hospital in patients in the continuous passive motion group was greater (91 degrees) compared with patients not treated with continuous passive motion (81 degrees), the range of motion in both groups at ultimate follow up was equivalent. However, when knee-rating scores were considered, patients treated with continuous passive motion averaged 9 points higher on a 100-point scale than patients not treated with continuous passive motion. In addition, the length of hospital stay for patients in the continuous passive motion group was 2.1 days shorter. We concluded that continuous passive motion was an effective adjunct to physiotherapy in the postoperative care of patients undergoing total knee arthroplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous Passive Motion Following Flexor Tendon Repair

A prospective study was performed of 20 consecutive patients with 35 flexor tendon lacerations, in whom post-operative mobilisation was carried out using the Toronto Mobilimb Continuous Passive Motion machine for the first 4 1/2 weeks. Overall the results assessed by Buck Gramcko criteria were 17 (85%) excellent or good, 3 (15%) fair and no poor results. Taking the 17 fingers with zone II lacerations, 14 (82%) were excellent or good, 3 (18%) fair and no poor results.

Continuous Passive Motion Versus Physical Therapy in Total Knee Arthroplasty

To determine the justification of a continuous passive motion machine in the treatment of postoperative total knee arthroplasties, a comparative study of 50 consecutive patients with simultaneous bilateral total knee arthroplasties was undertaken. The patients served as their own controls because one randomly selected knee was placed in the machine while the remaining knee was treated with physical therapy only. There was no significant difference in the range of motion during the eight days of hospitalization or the follow-up visits at two weeks, two months, six months, and one year. There was a significant decrease in the swelling about the knee. The continuous passive motion treated knees appeared to be generally weaker as revealed by more extensor lags and flexor tightness at discharge from the hospital. Also, increased costs incurred from the need for additional equipment and increased staff time made the machine neither cost-effective nor beneficial.

Continuous Passive Motion of the Knee Joint: Use at The Royal National Orthopaedic Hospital, Stanmore

Summary Use of the continuous passive motion machine has become widespread, yet there is very little written information to help physiotherapists. This article is intended to share some of the knowledge and experience we have gained over the past four years at the Royal National Orthopaedic Hospital, Stanmore. Brief details are given of the early research into the effects of continuous passive motion (CPM) and its relevance in the clinical field. Use of the CPM machine is described including application, and a standard treatment programme is recommended. Specific treatment programmes carried out at the RNOH after various types of knee surgery are explained in detail. The article concludes that CPM is a useful modality in rehabilitation of patients following knee surgery.

Morphological and biomechanical evaluations of neocartilage from the repair of full-thickness articular cartilage defects using rib perichondrium autografts: A long-term study

Neocartilage regenerated from rib perichondrium autografts implanted into full thickness cartilage defects made in the femoral condyle of rabbit knees were evaluated for periods up to 1 yr. Two postoperative treatment effects were studied, one with ad lib. caged activity (CAGE) and the other with the operated knee placed on a continuous passive motion machine for 2 weeks (8 h day −1 for 5 days week −1) followed by caged activity (PM). Animals were sacrificed at 6, 12, 26 and 52 weeks after surgery. The neocartilage was evaluated histologically and biomechanically and compared with the contralateral unoperated side. Visually, the neocartilage appeared to have an appearance similar to that of surrounding cartilage at 52 weeks, with an excellent degree of confluence with the neighboring tissue. The newly grown tissues were morphologically similar to normal hyaline articular cartilage. The dynamic shear moduli for the neocartilage from both the CAGE and PM groups significantly increased with postoperative healing time ( p<0.05). However, there was no statistical difference between the two treatment modalities ( p>0.10), indicating that the passive motion did not enhance the long-term repair of the cartilage defect. These results support our hypothesis that neocartilage regenerated from perichondrial autograft remains intact over time.

Synovectomy of the knee in young patients with hemophilia.

We performed 16 synovectomies of the knee in 14 children, adolescents, and young adults with hemophilia A for boggy synovium due to hemophilia. Pain was eliminated or decreased in all patients postoperatively. The number of bleeding episodes was dramatically decreased in all patients at three-year follow-up. Some knee motion was lost in five patients. A continuous passive motion machine used in patients operated upon later in the series appears to be beneficial in regaining motion. Synovectomy did not appear to alter the course of joint destruction, especially if done late.

The Role of Arthroscopy in the Treatment of Postoperative Fibroarthrosis of the Knee Joint

Twenty-one patients with significantly limited range of motion of the knee secondary to open surgical procedures were treated by arthroscopic resection of the adhesions and gentle manipulation. The surgical procedures consisted of realignment procedures for patellar dislocation, arthrotomy for meniscectomy and synovectomy, ligamentous reconstruction, open reduction of intraarticular fractures, and prosthetic replacement. The interval between the arthroscopic treatment and the open procedures was from four months to two years. All patients had the arthroscopic releases performed with general or spinal anesthesia, were kept in the hospital for a minimum of three days, and were placed on a continuous passive motion machine. After discharge, an intensive rehabilitation program was instituted under the supervision of a physical therapist. With a follow-up period ranging from six months to two years, marked improvement of range of motion was obtained in most patients. Preoperative flexion was between 40 degrees and 50 degrees in 13 patients, 30 degrees in two patients, 60 degrees in four patients, 80 degrees in one patient, and 10 degrees in only one patient. The final flexion was between 120 degrees and 140 degrees in 12 patients. The remaining patients had postoperative flexion between 85 degrees and 100 degrees. One patient with 10 degrees of range of motion did not improve. Six of the eight patients with an extension lag preoperatively regained full or almost full extension after arthroscopic debridement. Morbidity was low and no serious complications were encountered. This study suggests that arthroscopic intraarticular release of adhesions is efficacious in the management of arthrofibrosis of the knee subsequent to previous open operative procedures.

膝後十字靭帯再建術後の膝関節強直症例の治療経験

A patient with ankylosis of the right knee was referred to our hospital. The patient was found to have had reconstructive surgery of the posterior cruciate ligament 7 months previously. He underwent manipulation and arthroscopic treatment without improvement of 40 degrees of flexion deformity. Posterior release with excision of the anterior and posterior cruciate ligament was carried out in our hospital. Calcification and ossification were found in the proximal part of the anterior cruciate ligament, which was considered to be a cause of the restriction of knee extension.A good result was obtained by using a continuous passive motion machine and sponge traction immediately after the operation. Range of motion was from 0° to 150° of flexion one year after the surgery.

Comparison of two continuous passive motion protocols for patients with total knee implants.

We compared the effects of continuous passive motion (CPM) given for a minimum of 20 hours a day to Group 1 patients (n = 15) or a maximum of 5 hours a day to Group 2 patients (n = 8) who received total knee joint replacements. Four variables were analyzed on the third and sixth days after surgery: 1) range of motion, 2) edema-effusion, 3) pain, and 4) length of hospital stay. We found significant improvements in knee extension (p less [corrected] than .001) in the Group 2 patients on Day 6 after surgery. We also found a significant negative correlation between the length of hospital stay and the number of physical therapy treatments received. No between-group differences were found in measurements of 1) total knee excursion, 2) edema-effusion, 3) pain, 4) length of hospital stay, and 5) number of PT treatments received. This lack of differences implies that comparable results can be obtained by using the CPM machine either 20 hours a day or 5 hours a day.

Hormonal induction of osteoclastic phenotype from haemopoietic precursors in vitro

Use of the continuous passive motion machine has become widespread, yet there is very little written information to help physiotherapists. This article is intended to share some of the knowledge and experience we have gained over the past four years at the Royal National Orthopaedic Hospital, Stanmore. Brief details are given of the early research into the effects of continuous passive motion (CPM) and its relevance in the clinical field. Use of the CPM machine is described including application, and a standard treatment programme is recommended. Specific treatment programmes carried out at the RNOH after various types of knee surgery are explained in detail. The article concludes that CPM is a useful modality in rehabilitation of patients following knee surgery.

Continuous Passive Motion in the Treatment of Knee Flexion Contractures

Joint contractures are a problem frequently encountered by therapists. Methods of treating joint contractures traditionally have consisted of range-of-motion and stretching exercises. The medical literature suggests that, to be effective, ROM and stretching exercises must be performed with well-controlled speed, force, and duration. The patient in our case study used continuous passive motion machines after conventional methods of exercise failed. He subsequently demonstrated a 55-degree, bilateral reduction in knee flexion contractures. The purpose of this case report is to illustrate the use of continuous passive motion machines in the treatment of severe knee flexion contractures.