Does continuous passive motion decrease swelling
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The Impact of Continuous Passive Motion on Swelling Reduction
Introduction to Continuous Passive Motion (CPM)
Continuous Passive Motion (CPM) is a therapeutic technique used in postoperative rehabilitation, particularly after joint surgeries. It involves the use of a machine to move a joint continuously through a controlled range of motion. This article explores whether CPM effectively decreases swelling in patients post-surgery.
CPM and Swelling Reduction in Elbow Contracture
A study comparing CPM with physical therapy (PT) after arthroscopic release of elbow contracture found that CPM led to a faster recovery and greater range of motion at one year. Importantly, CPM also decreased swelling and reduced the loss of flexion strength, flexion endurance, and grip strength on day three post-surgery, although no significant differences were observed between the groups thereafter.
CPM in Anterior Cruciate Ligament (ACL) Reconstruction
In a randomized study involving patients with ACL ruptures, those who received CPM in combination with active motion (AM) exhibited less joint swelling compared to those who received AM only. This suggests that CPM can be beneficial in reducing swelling in the early postoperative period.
CPM and Total Knee Arthroplasty (TKA)
Several studies have investigated the effects of CPM following total knee arthroplasty (TKA):
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Immediate Cryotherapy and CPM: A study on patients undergoing computer-assisted TKA found that while there was no significant difference in joint swelling between the intervention (CPM and cryotherapy) and control groups, the intervention group had a lower mean joint swelling .
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Functional Recovery Post-TKA: Another study concluded that CPM did not provide any significant benefit in immediate functional recovery post-TKA and noted that postoperative knee swelling persisted longer in the CPM group.
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Comparative Study on Bilateral TKA: A comparative study on patients with bilateral TKA found a significant decrease in swelling in the knees treated with CPM compared to those treated with physical therapy alone.
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Controlled Evaluation of CPM: A controlled evaluation of CPM in TKA patients showed that CPM decreased swelling and the need for manipulations, although it did not significantly affect pain or quadriceps strength.
Experimental Models and Animal Studies
Experimental studies on animal models have also provided insights into the effects of CPM on swelling:
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Joint Stiffness and Swelling: An experimental study on rabbits demonstrated that 24 hours of passive motion significantly decreased limb swelling compared to immobilization.
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Synovitis and Cartilage Degradation: In a study on antigen-induced arthritis in rabbits, CPM-treated knees initially showed greater joint swelling and synovial effusion compared to immobilized knees. However, over a longer period, CPM was found to better preserve articular cartilage.
Conclusion
The evidence suggests that CPM can be effective in reducing swelling in the early postoperative period for various joint surgeries, including elbow contracture release and ACL reconstruction. However, its benefits in total knee arthroplasty are mixed, with some studies showing reduced swelling and others indicating no significant difference or even prolonged swelling. Further research is needed to fully understand the conditions under which CPM is most beneficial for swelling reduction.
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