PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2011

Clinical Scenario

The patient who led me to pursue this question is: A 62 y/o female s/p Total Knee Replacement (TKA) with moderate knee edema, range of motion (ROM) deficits, and gait abnormalities. Medical treatment to date has included medication, ice, rest (non-use), elevation, compression bandages, and continuous flow cold compression therapy.

Clinical Question

Is continuous flow cold compression therapy better than ice and/or compression alone for the treatment of post-operative Total Knee Replacements?

Clinical Bottom Line

Based on the results of the outcomes from Healy et al. and Barber et al…

Due to the poor/fair study designs of both articles and the difference in interventions and patient populations between them, I can state that these studies gave me only a few pieces to answer my clinical question. First of all, I can say with moderate confidence that the continuous flow cold therapy machine is more effective than crushed ice in increasing knee PROM and decreasing pain (but not vicodin use) in the first week following ACL repair surgery. It is also important to note that the machine is very expensive compared the small amount of insurance reimbursement per PT billing code.

Secondly, the costs of the Cryo Cuff (an older version of the Game Ready without continuous flow) outweigh its possible benefits (ROM, swelling, narcotic use) when substituted for ice and compression bandaging in patients following TKA surgery. Together these studies would not convince me to buy a Game Ready machine for my outpatient clinic. However, if my clinic already had one I would use it with both TKA and ACL repair patients.

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