Healthcare Paper on Effect of adjunctive range of motion therapy after primary total knee arthroplasty

Effect of adjunctive range of motion therapy after primary total knee arthroplasty

Introduction

Total knee replacement or total knee arthroplasty (TKA) is the best medical procedure when treating an arthritic knee in reference to other treatments such as Weight loss, use of knee braces, injections or physical therapy. According to Brugioni and Jeffrey, the purpose of TKA surgery is to reduce arthritic pain, improve the patient’s quality of life, as well as maintain or in other cases improve knee function (230). The report by Affatato indicated that roughly 700,000 knee replacement procedures are currently performed annually in the United States (56). Nonetheless, despite the successes of TKA as a medical procedure, its rehabilitation measures remain controversial. Continuous passive motion (CPM) used along with to standardized exercises (SEs) is regarded as the standard treatment after TKA. It is believed that patients who receive CPM as an additional recovery procedure have a quicker hospital discharge ratio in addition to reduced post discharge complications. However, this perception remains to be proven. This paper offers an in-depth comprehension of the effect of the adjunctive range of motion or CPM therapy after primary total knee arthroplasty in reference to discharge period, as presented by the University of Alberta Hospital study. 

Continuous Passive Motion

Continuous passive motion (CPM) is employed as a standard patient recovery procedure after total knee arthroplasty (TKA). CPM, in particular, the slider board (SB) is a mechanical device that is made up of an adjustable heel-cup fixed to a minimal friction movable mechanism. It allows a patient to extensively flex and extend the knee with minimal muscle (quadriceps and hamstring) strain (Scott 67). The benefits of such mechanisms are expected to reduce inpatient discharge from acute care; this is because the SB device is expected to facilitate swift knee functional recovery than when a patient is placed only on SEs. Additionally, SBs reduce the number of complications after discharge from the hospital. Nonetheless, the costs of employing CPM therapy have prompted clients to overlook the benefits mentioned above. A standard SB device costs approximately CD $50 to CD$200; however, other CMP mechanisms costs within the range of CD$2500 and CD$9700. Additionally, though SB may be simple to use other CPM devices require nursing or technical assistance.

University of Alberta Hospital study on effects of CMP on TKA Recovery

A study conducted by the University of Alberta Hospital highlighted that the medical benefits of using CMP therapy may not be actual. The study included 120 patients who had gone through TKA procedures. The sample was later divided into three segments. The first sample that included 40 patients received both CMP and SB therapy along with standard SEs. The second sample likewise made up of 40 patients received SB therapy only, while the last sample received SEs therapy without any inclusion of SB theory. Patients are allowed to be charged through various measures or parameters; however, increased studies centered on a range of movement (ROM) procedure as a standard reason for discharge. Patients with less than 600 knee flexion were mentioned to have poor ROM and would be expected to visit physicians for extra therapy. Patients with 600 flexions would be discharged. On the other hand, patients with 900 knee flexion would be discharged on the advice that they would continue recovery on their own schedule.   

Analysis of the University of Alberta Hospital Study Results

From the medical perceptions offered, it was expected that patients who received CMP therapy would have quicker knee functional recovery than their counterpart. However, after six months, the recovery period seemed not to have been dissimilar. Additionally, the three samples highlighted patients who had poor, average, as well as good ROM. From the survey, it is evident that SB does not reduce inpatient recovery time. The short-term advantages such as fewer manipulations or reduced readmissions associated with the use of SB as indicated in other studies were also not evident in this study. Over the 60-day period, patients who received GPM had individuals with poor, average, as well as improved knee flexing rotation. Additionally, the same can be said about patients who received SEs for recovery. Subsequently, this study indicates that CMP or SB had minimal or no effects on reducing inpatient period or improving knee flexing motion. After discharge, it was anticipated that patients that were placed under GPM recovery procedures would have less after surgery complications; however, the results from the survey indicated that this was not the case. All the patients who had recovery issues were discharged with poor ROMs and they were present in all categories.     

Verdict

From the study, the effects of CPM on the adjunctive range of motion therapy after primary total knee arthroplasty. However, this does not mean that the treatment procedure should be disregarded during TAK recovery. Due to the difference in results from other studies, it can be debated that long-term use of either CPM or SB therapies would produce different results.

Conclusion

Continuous passive motion (CPM) is employed as a standard patient recovery procedure after total knee arthroplasty (TKA). The benefits of such mechanisms are expected to reduce inpatient discharge from acute care, which is because the SB device is expected to facilitate swift knee functional recovery than when a patient is placed only on SEs. However, after reviewing the study by the University of Alberta Hospital, it can be argued that these benefits are not achievable. However, due to the difference from other studies, it can be argued that long-term use of either CPM or SB therapies would produce different results.   

Works Cited

Affatato, Saverio. Surgical Techniques in Total Knee Arthroplasty and Alternative Procedures. Elsevier Science, 2016. Internet resource.

Brugioni, Daniel J, and Jeffrey E. Falkel. Total Knee Replacement and Rehabilitation: The Knee Owner’s Manual. Alameda, CA: Hunter House, 2004.

Davies, D. M., Johnston, D. W. C., Beaupre, L. A., & Lier, D. A. (2003). Effect of adjunctive range-of-motion therapy after primary total knee arthroplasty on the use of health services after hospital discharge. Canadian Journal of Surgery46(1), 30.

Scott, Richard D. Total Knee Arthroplasty. London: Elsevier Health Sciences, 2014.