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Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy

Abstract

Purpose

Despite multimodal pain management and advances in anesthetic techniques, total knee arthroplasty (TKA) remains painful during the early postoperative phase. This trial investigated whether computer-assisted cryotherapy (CAC) is effective in reduction of pain and consumption of opioids in patients operated for TKA following an outpatient surgery pathway.

Methods

Sixty patients scheduled for primary TKA were included in this prospective, double-blind, randomized controlled trial receiving CAC at 10–12 °C (Cold-group, n = 30) or at 21 °C (Warm-group, n = 30) during the first 7 days after TKA according to a fixed schedule. All patients received the same pre-, peri- and postoperative care with a multimodal pain protocol. Pain was assessed before and after every session of cryotherapy using the numerical rating scale for pain (NRS-pain). The consumption of opioids was strictly noted during the first 4 postoperative days. Secondary outcomes were knee swelling, visual hematoma and patient reported outcome measures (PROMs). These parameters were measured pre-, 1, 2 and 6 weeks postoperatively.

Results

In both study groups, a reduction in NRS-pain after every CAC session were seen during the postoperative period of 7 days. A mean reduction of 0.9 and 0.7 on the NRS-pain was seen for respectively the Cold- (P = 0.008) and Warm-group (n.s.). A significant (P = 0.001) lower number of opioids were used by the Cold-group during the acute postoperative phase of 4 days, 47 and 83 tablets for respectively the Cold and Warm-group. No difference could be observed for secondary outcomes and adverse effects between both study groups.

Conclusions

Postoperative CAC can be in added value in patients following an outpatient surgery pathway for TKA, resulting in reduced experienced pain and consumption of opioids during the first postoperative days.

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Funding

No financial support was received for this study.

Author information

Authors and Affiliations

Authors

Contributions

Elke Thijs: Designed the study, gathered and analyzed all the data, wrote the initial draft of the manuscript and managed the study. Martijn G.M. Schotanus: Designed the study, analyzed the data, wrote and revised the manuscript and managed the study. Yoeri F.L. Bemelmans: Gathered data, wrote and revised the manuscript. Nanne P Kort: Conceived the study and revised the manuscript.

Corresponding author

Correspondence to Elke Thijs.

Ethics declarations

Conflict of interest

One author, Nanne Kort, is a paid consultant for Zimmer-Biomet, Europe. The other authors certify that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript.

Ethical approval

The study was approved by the ethics committee of Zuyderland-Zuyd, Number 15-T-135 and registered online at the Dutch Trial Register (http://www.trialregister.nl, No. NTR5565).

Informed consent

For this type of study formal informed consent was obtained from each included patient.

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Thijs, E., Schotanus, M.G.M., Bemelmans, Y.F.L. et al. Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy. Knee Surg Sports Traumatol Arthrosc 27, 1204–1212 (2019). https://doi.org/10.1007/s00167-018-4962-y

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  • DOI: https://doi.org/10.1007/s00167-018-4962-y

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