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Clinical Orthopaedics and Related Research®

, Volume 472, Issue 11, pp 3417–3423 | Cite as

Does Advanced Cryotherapy Reduce Pain and Narcotic Consumption After Knee Arthroplasty?

  • Emmanuel Thienpont
Clinical Research

Abstract

Background

Cryotherapy has been used to enhance recovery after orthopaedic surgery. Several cooling devices are available but few can guarantee a fixed temperature during a prolonged time and therefore have been criticized. The arrival of new advanced cryotherapy devices made it possible to test the effect of prolonged cooling on rehabilitation after joint replacement.

Questions/purposes

The hypotheses of this randomized controlled trial (RCT) were that advanced cryotherapy devices compared with cold packs result in (1) better postoperative pain control resulting in a lower consumption of narcotics; (2) better early ROM; and (3) less postoperative bleeding and swelling.

Methods

A priori sample size calculation had determined that to detect a difference of 2 points on the VAS, a sample size of 50 subjects per group at followup would be required, given a study power of 80%. One hundred sixteen patients were included and randomly allocated to receive advanced cryotherapy (n = 58) or use of cold packs (n = 58). The primary outcomes for the study were to evaluate pain with the VAS and analgesics consumption. Secondary outcomes were postoperative ROM, swelling, and blood loss. One hundred (50 in each group) patients had complete data available for analysis.

Results

No statistically significant differences in VAS, need for analgesics, nor in secondary outcomes were observed, except for substantially reduced flexion at 6 weeks in the advanced cryotherapy group (114° versus 120°).

Conclusions

Advanced cryotherapy with a continuous temperature for a prolonged period does not deliver expected results of superior early recovery after knee arthroplasty. Greater sample sizes are required to fully determine significant differences between the two techniques for these study parameters. Immobilization of the knee in extension during the prolonged cryotherapy session resulted in lower active flexion at 6 weeks after surgery for the advanced cryotherapy group. Advanced cryotherapy should not be used in fast track knee arthroplasty if the economic cost is higher than the price of cold packs or offers no other concomitant advantages.

Level of Evidence

Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Keywords

Total Knee Arthroplasty Tramadol Hide Blood Loss Cold Pack Subvastus Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Vanessa Briart PT, from Saint Luc University hospital for prospective functional outcome data collection, Bertin Wasamba MD, from Saint Luc University hospital for Excel file data collection, Pat Viroux PT and Hans Van Buynder PT from Waegener (Beerse, Belgium) for advice regarding cryotherapy and the study protocol, and Levi Dewaegenaere CEO, of Waegener (Beerse, Belgium) for the free cPad delivery.

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Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  1. 1.Cliniques Universitaires Saint Luc-UCLBrusselsBelgium

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