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Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study evaluated the clinical efficacy of continuous passive motion (CPM) following knee arthroplasty and determined the predictors of effect sizes of range of motion (ROM) and functional outcomes in patients with knee arthritis.

Methods

A comprehensive electronic database search was performed for randomized controlled trials (RCTs), without publication year or language restrictions. The included RCTs were analyzed through meta-analysis and risk of bias assessment. Study methodological quality (MQ) was assessed using the Physiotherapy Evidence Database (PEDro) scale. Inverse-variance weighted univariate and multivariate metaregression analyses were performed to determine the predictors of treatment outcomes.

Results

A total of 77 RCTs with PEDro scores ranging from 6/10 to 8/10 were included. Meta-analyses revealed an overall significant favorable effect of CPM on treatment success rates [odds ratio: 3.64, 95% confidence interval (CI) 2.21–6.00]. Significant immediate [postoperative day 14; standard mean difference (SMD): 1.06; 95% CI 0.61–1.51] and short-term (3-month follow-up; SMD: 0.80; 95% CI 0.45–1.15) effects on knee ROM and a long-term effect on function (12-month follow-up; SMD: 1.08; 95% CI 0.28–1.89) were observed. The preoperative ROM, postoperative day of CPM initiation, daily ROM increment, and total application days were significant independent predictors of CPM efficacy.

Conclusion

Early CPM initiation with rapid progress over a long duration of CPM application predicts higher treatment effect on knee ROM and function. The results were based on a moderate level of evidence, with good MQ and potential blinding biases in the included RCTs. An aggressive protocol of CPM has clinically relevant beneficial short-term and long-term effects on postoperative outcomes.

Level of evidence

II.

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References

  1. Alzahrani K, Gandhi R, Debeer J, Petruccelli D, Mahomed N (2011) Prevalence of clinically significant improvement following total knee replacement. J Rheumatol 38(4):753–759

    Article  PubMed  Google Scholar 

  2. Basso DM, Knapp L (1987) Comparison of two continuous passive motion protocols for patients with total knee implants. Phys Ther 67(3):360–363

    Article  CAS  PubMed  Google Scholar 

  3. Bennett LA, Brearley SC, Hart JA, Bailey MJ (2005) A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. J Arthroplasty 20(2):225–233

    Article  PubMed  Google Scholar 

  4. Bowden J, Tierney JF, Copas AJ, Burdett S (2011) Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol 11:41–53

    Article  PubMed  PubMed Central  Google Scholar 

  5. Briani RV, Ferreira AS, Pazzinatto MF, Pappas E, De Oliveira Silva D, Azevedo FM (2018) What interventions can improve quality of life or psychosocial factors of individuals with knee osteoarthritis? A systematic review with meta-analysis of primary outcomes from randomised controlled trials. Br J Sports Med 52(16):1031–1038

    Article  PubMed  Google Scholar 

  6. Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L et al (2004) Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. J Rheumatol 31(11):2251–2264

    PubMed  Google Scholar 

  7. Carifio J, Perla RJ (2007) Ten common misunderstandings, misconceptions, persistent myths and urban legends about likert. J Soc Sci 3(3):106–116

    Google Scholar 

  8. Chiarello CM, Gundersen L, O’Halloran T (1997) The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. J Orthop Sports Phys Ther 25(2):119–127

    Article  CAS  PubMed  Google Scholar 

  9. Cohen J (1988) The analysis of variance. In: Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, pp 273–406

    Google Scholar 

  10. de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55(2):129–133

    Article  PubMed  Google Scholar 

  11. Dennis DA, Komistek RD, Scuderi GR, Zingde S (2007) Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res 464:53–60

    PubMed  Google Scholar 

  12. Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL (2009) Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg 18(4):652–660

    Article  PubMed  Google Scholar 

  13. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Farahini H, Moghtadaei M, Bagheri A, Akbarian E (2012) Factors influencing range of motion after total knee arthroplasty. Iran Red Crescent Med J 14(7):417–421

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Grella RJ (2008) Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation? Phys Ther Rev 13(4):269–279

    Article  Google Scholar 

  16. Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 75(6):950–955

    Article  CAS  PubMed  Google Scholar 

  17. Harvey LA, Brosseau L, Herbert RD (2014) Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev 2:CD004260

    Google Scholar 

  18. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD et al (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  19. Higgins JPT, Deeks JJ, Altman DG (2011) Chapter 16: special topics in statistics. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]: the cochrane collaboration. http://handbook.cochrane.org. Accessed Jun 04, 2018

  20. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The cochrane collaboration. http://handbook.cochrane.org. Accessed Jun 04, 2018

  21. Hopkins WG (2002) A scale of magnitudes for effect statistics a new view of statistics. http://sportsci.org/resource/stats/effectmag.html. Accessed Jun 04, 2018

  22. Jarvenpaa J, Kettunen J, Kroger H, Miettinen H (2010) Obesity may impair the early outcome of total knee arthroplasty. Scand J Surg 99(1):45–49

    Article  CAS  PubMed  Google Scholar 

  23. Johnson DP, Eastwood DM (1992) Beneficial effects of continuous passive motion after total condylar knee arthroplasty. Ann R Coll Surg Engl 74(6):412–416

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Lachiewicz PF (2000) The role of continuous passive motion after total knee arthroplasty. Clin Orthop Relat Res 380:144–150

    Article  Google Scholar 

  25. Liao CD, Huang YC, Chiu YS, Liou TH (2017) Effect of body mass index on knee function outcome following continuous passive motion in patients with osteoarthritis after total knee replacement. Physiotherapy 103(3):266–275

    Article  PubMed  Google Scholar 

  26. Liao CD, Huang YC, Lin LF, Chiu YS, Tsai JC, Chen CL et al (2016) Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24(8):2578–2586

    Article  PubMed  Google Scholar 

  27. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH (2015) Body mass index and functional mobility outcome following early rehabilitation after a total knee replacement: a retrospective study in taiwan. Arthr Care Res (Hoboken) 67(6):799–808

    Article  Google Scholar 

  28. MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW, Kramer J, Vaz M (2000) Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty. Clin Orthop Relat Res (380):30–35

  29. Maniar RN, Baviskar JV, Singhi T, Rathi SS (2012) To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery. J Arthroplasty 27(2):193–200 e1

    Article  PubMed  Google Scholar 

  30. Mayo BS, Rodriguez-Mansilla J, Sanchez BG (2015) Recovery from total knee arthroplasty through continuous passive motion. An Sist Sanit Navar 38(2):297–310

    Article  Google Scholar 

  31. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1

    Article  PubMed  PubMed Central  Google Scholar 

  32. Moseley AM, Herbert RD, Sherrington C, Maher CG (2002) Evidence for physiotherapy practice: a survey of the physiotherapy evidence database (PEDro). Aust J Physiother 48(1):43–49

    Article  PubMed  Google Scholar 

  33. Naylor JM, Ko V, Rougellis S, Green N, Mittal R, Heard R et al (2012) Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2. J Eval Clin Pract 18(3):652–658

    Article  PubMed  Google Scholar 

  34. Norman G (2010) Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract 15(5):625–632

    Article  PubMed  Google Scholar 

  35. O’Driscoll SW, Giori NJ (2000) Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev 37(2):179–188

    PubMed  Google Scholar 

  36. Postel JM, Thoumie P, Missaoui B, Biau D, Ribinik P, Revel M et al (2007) Continuous passive motion compared with intermittent mobilization after total knee arthroplasty. Elaboration of French clinical practice guidelines. Ann Readapt Med Phys 50(4):244–257

    Article  PubMed  Google Scholar 

  37. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 85-A(7):1278–1285

    Article  Google Scholar 

  38. Salter RB (1989) The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res (242):12–25

  39. Sedgwick P, Marston L (2015) How to read a funnel plot in a meta-analysis. BMJ 351:1–3

    Google Scholar 

  40. Sterne JAC, Egger M, Moher D (2011) Chapter 10: addressing reporting biases. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The cochrane collaboration. http://www.handbook.cochrane.org. Accessed 12 Oct 2018

  41. Tedesco D, Gori D, Desai KR, Asch S, Carroll IR, Curtin C et al (2017) Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis. JAMA Surg 152(10):e172872

    Article  PubMed  PubMed Central  Google Scholar 

  42. van Dijk HJD, Elvers JWH, Ruijter A, Oostendorp RAB (2007) Effect of continuous passive motion after total knee arthroplasty: a systematic review. Phys Singap 10(4):9–19

    Google Scholar 

  43. van Tulder M, Furlan A, Bombardier C, Bouter L (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 28(12):1290–1299

    Google Scholar 

  44. Viswanathan PKM (2010) Effect of continuous passive motion following total knee arthroplasty on knee range of motion and function: a systematic review. New Zeal J Physiother 38(3):14–22

    Google Scholar 

  45. Winemaker M, Rahman WA, Petruccelli D, de Beer J (2012) Preoperative knee stiffness and total knee arthroplasty outcomes. J Arthroplasty 27(8):1437–1441

    Article  PubMed  Google Scholar 

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Funding

This study was funded by grants from Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, Taiwan (grant no. W107HCP-04). The funding source had no role in the design, implementation, data analysis and interpretation, or reporting of the study. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the funding sources.

Author information

Author notes

  1. Tsan-Hon Liou and Yen-Shuo Chiu equally contributed to this study.

Authors and Affiliations

  1. School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Chun-De Liao & Jau-Yih Tsauo

  2. Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Chun-De Liao, Shih-Wei Huang, Hung-Chou Chen & Tsan-Hon Liou

  3. Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan

    Shih-Wei Huang

  4. Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Hung-Chou Chen

  5. Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan

    Hung-Chou Chen & Tsan-Hon Liou

  6. Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Yen-Shuo Chiu

  7. Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan

    Tsan-Hon Liou

Authors
  1. Chun-De Liao
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Correspondence to Tsan-Hon Liou.

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The authors declare that they have no conflict of interest related to the publication of this article.

Ethical approval

This study dealt with published data only, no ethical approval has been necessary since sensitive information has not been provided or utilized in this review.

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Liao, CD., Tsauo, JY., Huang, SW. et al. Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis. Knee Surg Sports Traumatol Arthrosc 27, 1259–1269 (2019). https://doi.org/10.1007/s00167-018-5257-z

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  • DOI: https://doi.org/10.1007/s00167-018-5257-z

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