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The role of computer-assisted cryotherapy in the postoperative treatment after total knee arthroplasty: positive effects on pain and opioid consumption



The aim of this study was to investigate whether computer-assisted cryotherapy is effective in reducing postoperative pain and analgesics consumption, next to improving functional outcome and patient satisfaction after total knee arthroplasty (TKA). The hypothesis is that computer-assisted cryotherapy has positive effects on postoperative pain after TKA.


A single-centre non-blinded randomised controlled trial was designed to study the early (first postoperative week) and late (2 and 6 weeks postoperatively) additive effect of computer-assisted cooling after TKA. Participants scheduled for a TKA were randomly allocated to a cold (cryotherapy) C-group or a regular (control) R-group. Next to usual postoperative care for both groups, the C-group received computer-assisted cryotherapy during the first seven postoperative days. Primary outcome was pain, monitored with the numerical rating scale for pain and use of opioid escape medication. Secondary outcomes were function and swelling, monitored by active range of motion, timed up and go test and circumference measurements; patient-reported outcome measurements (KOOS and WORQ questionnaires); and patient satisfaction, monitored by the numerical rating scale for satisfaction.


102 patients participated in this study, both groups contained 51 patients. On most days during the first week, patients in the C-group scored significantly lower NRS pain scores and registered significantly less use of opioid escape medication. In a sub-analysis of 57 patients using the same standard pain protocol, patients in the C-group (n = 28) used less oxycodone during the first postoperative week. There were no significant differences between both groups in active range of motion, timed up and go, or circumference measurements. For the WORQ questionnaire, there was a significant difference between the two groups 6 weeks postoperatively in favour of the C-group. This could be however due to a reduced validity of this questionnaire shortly after TKA. The satisfaction score was not significantly different between both groups.


Computer-assisted cryotherapy following TKA can be beneficial during the first postoperative week in terms of pain reduction and diminished opioid consumption. No clear differences in knee function or swelling were seen.

Level of evidence

Therapeutic study with level of evidence I.

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Fig. 3



Activities of daily living


Active range of motion


American Society of Anaesthesiologists


Body mass index


Computer-assisted cryotherapy


Knee Injury and Osteoarthritis Outcome Score


Minimal important change


Numeric rating scale




Postoperative day


Patient-reported outcome measurements


Randomised controlled trial


Range of motion


Rapid recovery


Total knee arthroplasty


Timed up and go


Work, Osteoarthritis and Joint-Replacement Questionnaire


Weeks postoperatively


  1. Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J (2007) Influence of patient factors on TKA outcomes at 5 to 11 years followup. Clin Orthop 464:27–31

    Article  Google Scholar 

  2. Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM (2016) Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthr Cartil 24(8):1317–1329

    Article  CAS  Google Scholar 

  3. Jakobsen TL, Christensen M, Christensen SS, Olsen M, Bandholm T (2010) Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter? Physiother Res Int 15(3):126–134

    Article  Google Scholar 

  4. Kendrick DB, Strout TD (2005) The minimum clinically significant difference in patient-assigned numeric scores for pain. Am J Emerg Med 23(7):828–832

    Article  Google Scholar 

  5. Kievit AJ, Kuijer PP, Kievit RA, Sierevelt IN, Blankevoort L, Frings-Dresen MH (2014) A reliable, valid and responsive questionnaire to score the impact of knee complaints on work following total knee arthroplasty: the WORQ. J Arthroplasty 29(6):1169–1175

    Article  Google Scholar 

  6. Kong L, Cao J, Zhang Y, Ding W, Shen Y (2017) Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 14(3):529–536

    Article  Google Scholar 

  7. Levy N, Quinlan J, El-Boghdadly K, Fawcett WJ, Agarwal V, Bastable RB, Cox FJ, de Boer HD, Dowdy SC, Hattingh K, Knaggs RD, Mariano ER, Pelosi P, Scott MJ, Lobo DN, Macintyre PE (2020) An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia 76:520–536

    Article  Google Scholar 

  8. Martin SS, Spindler KP, Tarter JW, Detwiler KB (2002) Does cryotherapy affect intraarticular temperature after knee arthroscopy? Clin Orthop 400:184–189

    Article  Google Scholar 

  9. Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L (2011) Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty 26(5):728–737

    Article  Google Scholar 

  10. Namba RS, Inacio MC, Paxton EW (2013) Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Jt Surg Am. 95(9):775–782

    Article  Google Scholar 

  11. Ruffilli A, Castagnini F, Traina F, Corneti I, Fenga D, Giannini S, Faldini C (2017) Temperature-controlled continuous cold flow device after total knee arthroplasty: a randomized controlled trial study. J Knee Surg 30(7):675–681

    Article  Google Scholar 

  12. Sadoghi P, Hasenhütl S, Gruber G et al (2018) Impact of a new cryotherapy device on early rehabilitation after primary total knee arthroplasty (TKA): a prospective randomised controlled trial. Int Orthop 42(6):1265–1273

    Article  Google Scholar 

  13. Soffin EM, YaDeau JT (2016) Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth. 117(suppl 3):iii62–iii72

    Article  CAS  Google Scholar 

  14. Thacoor A, Sandiford NA (2019) Cryotherapy following total knee arthroplasty: what is the evidence? J Orthop Surg 27(1):1–6

    Google Scholar 

  15. Thienpont E (2014) Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty? Clin Orthop 472(11):3417–3423

    Article  Google Scholar 

  16. Thijs E, Schotanus MGM, Bemelmans YFL, Kort NP (2019) Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy. Knee Surg Sports Traumatol Arthrosc 27(4):1204–1212

    Article  Google Scholar 

  17. Yuksel E, Kalkan S, Cekmece S, Unver B, Karatosun V (2017) Assessing minimal detectable changes and test-retest reliability of the timed up and go test and the 2-minute walk test in patients with total knee arthroplasty. J Arthroplasty 32(2):426–430

    Article  Google Scholar 

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We thank M.J. de Ronde and J.M. Hut-de Jong for their practical work on this project.


The study was funded by the Martini research and innovation fund.

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Correspondence to Hugo F. G. Brouwers.

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The authors declare that they have no conflict of interest.

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The Local Medical Ethics Committee approved the study protocol (MEC no. 2018-128).

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All participants gave signed informed consent before participation.

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Brouwers, H.F.G., de Vries, A.J., van Zuilen, M. et al. The role of computer-assisted cryotherapy in the postoperative treatment after total knee arthroplasty: positive effects on pain and opioid consumption. Knee Surg Sports Traumatol Arthrosc 30, 2698–2706 (2022).

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