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Cold therapy following total knee replacement surgery

Discussion in 'Knees - TKR' started by Josephine, Feb 19, 2017.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    Cold therapy following total knee replacement surgery
    Published: 12 September 2012 Authors: Adie S, Kwan A, Naylor JM, Harris IA, Mittal R

    This summary of a Cochrane review presents what we know from research about the effects of cold therapy as a therapeutic intervention right after total knee replacement surgery for patients with osteoarthritis.

    The review shows that in people who have had a total knee replacement:
    - Cryotherapy
    - may slightly reduce the amount of blood loss and pain
    - was generally safe and not associated with any serious adverse events
    - may improve the range of movement at the knee in the first one to two weeks after surgery
    - no studies were found that looked at the effects of cryotherapy on a person's activities
    related to knee function (or quality of life, or general activity level)​

    What is cold therapy?
    Cold therapy (or cryotherapy) involves the application of very low temperatures to the skin surrounding an injury or surgical site. This can be by means of bags of ice or specialised devices that deliver cooled water to the area.

    This review shows that there is evidence that cryotherapy may reduce pain and increase the range of movement in the first few days after a total knee replacement. Use of cryotherapy is safe and did not result in an increase in serious complications.

    Best estimate of what happens to people who have a total knee replacement and receive cryotherapy:

    Pain
    - People who received cryotherapy reported less pain day 2 postoperatively but pain levels at day 1 and day 3 showed no difference.

    Adverse events (unwanted effect including discomfort, local skin reactions, skin infections, cold-related injuries and blood clots)
    - 34 out of 1000 people who received cryotherapy experienced one or more unwanted effects
    - 34 out of 1000 people who did not receive cryotherapy also experienced one or more unwanted effects

    Range of motion
    - People who received cryotherapy were able to bend their knee 11 degrees more at the time of
    discharge from hospital​

    Function

    - There was no evidence found about the effects of cryotherapy on knee function

    Authors' conclusions:
    Potential benefits of cryotherapy on blood loss, postoperative pain, and range of motion may be too small to justify its use, and the quality of the evidence was very low or low for all main outcomes. This needs to be balanced against potential inconveniences and expenses of using cryotherapy. Well designed randomised trials are required to improve the quality of the evidence.

    Background:
    Total knee replacement (TKR) is a common intervention for patients with end-stage osteoarthritis of the knee. Post-surgical management may include cryotherapy. However, the effectiveness of cryotherapy is unclear.

    Objectives:
    To evaluate the acute (within 48 hours) application of cryotherapy following TKR on pain, blood loss and function.

    Data collection and analysis:
    Two reviewers independently selected trials for inclusion. Disagreements were discussed and resolved involving a third reviewer if required. Data were then extracted and the risk of bias of trials assessed. Main outcomes were visual analogue score (VAS) pain, adverse events, knee range of motion and knee function. Secondary outcomes were analgesia use, knee swelling, length of hospital stay, quality of life and activity level. Effects of interventions were estimated as mean differences, standardised mean differences or given as risk ratios with 95% confidence intervals.

    Main results:
    Eleven randomised trials and one controlled clinical trial involving 809 participants met the inclusion criteria. There is very low quality evidence from 10 trials (666 participants) that cryotherapy has a small benefit on blood loss equivalent to 225mL less blood loss in cryotherapy group. This benefit may not be clinically significant.

    There was very low quality evidence from four trials (322 participants) that cryotherapy improved visual analogue score pain at 48 hours, but not at 24 or 72 hours. This benefit may not be clinically significant.

    There was no difference between groups in adverse events. There is low quality evidence from two trials (107 participants) for improved range of motion at discharge, but this benefit may not be clinically significant. There was no difference between groups in transfusion rate and knee function was not measured in any trial. No significant benefit were found for analgesia use, swelling or length of stay. Outcomes measuring quality of life or activity level were not reported.
     

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