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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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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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Abbreviations

ADL:

Activities of daily living

AROM:

Active range of motion

ASA:

American Society of Anaesthesiologists

BMI:

Body mass index

CAC:

Computer-assisted cryotherapy

KOOS:

Knee Injury and Osteoarthritis Outcome Score

MIC:

Minimal important change

NRS:

Numeric rating scale

OA:

Osteoarthritis

POD:

Postoperative day

PROMs:

Patient-reported outcome measurements

RCT:

Randomised controlled trial

ROM:

Range of motion

RR:

Rapid recovery

TKA:

Total knee arthroplasty

TUG:

Timed up and go

WORQ:

Work, Osteoarthritis and Joint-Replacement Questionnaire

WPO:

Weeks postoperatively

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Acknowledgements

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

Funding

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

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Authors

Corresponding author

Correspondence to Hugo F. G. Brouwers.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

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). https://doi.org/10.1007/s00167-021-06568-x

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Keywords

  • Computer-assisted cryotherapy
  • Cooling
  • Total knee arthroplasty
  • Total knee replacement
  • Pain
  • Opioids
  • Knee function
  • PROMs