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Standardized Continuous Passive Motion Protocols For Total Knee Arthroplasty: A Delphi Technique Study of Oregon and Hawaii

1 May 2005


Background and Purpose. Continuous Passive Motion (CPM) use postoperatively has become standard practice for synovial joint surgeries, especially with a Total Knee Arthroscopy (TKA). Reduction in post-operative complications have been well documented including: decreased swelling, edema, length of stay, and surgical manipulations, as well as, an increase in knee flexion active range of motion (AROM).5, 6, 8,9,11,12,13,14,15,18,21 This leads to a better outcome for the patient and hospital due to its cost-effectiveness.5 , 6, 15 Although much of the current literature strongly recommends the use of CPM, there is not a standard protocol for parameters such as, time use (during 24-hour period), velocity (cycles/min), as well as, starting and progressing knee ROM through discharge from the hospital. We believe having a protocol standard would increase CPM effectiveness and outcomes for both patient and physical therapist. The purpose of this study was to survey orthopedic surgeons throughout Oregon and Hawaii on their use of CPM with TKA, using a Delphi technique survey format. This survey was conducted to facilitate a general consensus among professionals on the most effective CPM protocol for the typical TKA patient.

Methods. Data for this project was gathered from three mailings to practicing orthopedic surgeons, residing within Oregon and Hawaii. The initial mailing asked each individual to complete and return a questionnaire stating their, or the facilities, CPM protocol for a TKA patient, including a justification for their protocol. From the initial questionnaire we determined the top three choices for each of the following parameters: when CPM should be first administered after surgery, initial flexion and extension settings, speed of each cycle, how long the machine is left on during a 24-hour period, how the CPM should be progressed throughout its use, when the machine should be discontinued, and the surgeons rationale for using CPM with aTKA. These were then sent back to the same group of surgeons to be rank ordered. From this we found our results and sent out a final mailing for clarification and comments.

Results. The recovery room was ranked the most effective time to administer the CPM device. The most commonly used CPM setting for initial extension post-operatively was 0 degrees followed by 45 degrees for initial flexion. The highest ranked CPM speed was as tolerated by patient, and determined it should be left on continuously until discharge from the hospital. The progression of knee ROM in the CPM was to be progressed as tolerated by the patient each day. In answer to the question involving rationale for CPM use, it was overwhelmingly decided to encourage early ROM post-operatively.

Conclusion and Discussion. The present study is the first Delphi style survey carried out among orthopedic surgeons to find a standardized CPM protocol. We believe that our protocol could be used as an addition to the rehabilitation program in any hospital throughout Oregon or Hawaii.


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