Cryotherapy with compression may speed post-TKA mobilization while controlling pain

Patients treated with cold compression had significantly better range of motion upon discharge and at 3 weeks follow-up compared to controls.

Cryotherapy combined with compression can effectively control pain after total knee arthroplasty, and may improve postop range of motion, a prospective study found.

Björn Kullenberg, MD, and colleagues in Sweden randomly assigned 86 patients to receive either 3 days of cryotherapy and compression or 3 days of standard postop analgesia.

The cryotherapy group included 41 patients with an mean age of 68 years treated with the Cryocuff (Aircast), which was rechilled hourly. The control group included 45 patients with a mean age of 69 years. These patients received standard postop analgesia consisting of 3 days of ropivacain epidural analgesia followed by intravenous NSAIDs and opioids.

The data analysis excluded one patient in each group who developed deep vein thrombosis and one cold compression patient who developed a superficial soft tissue infection.

The researchers found that patients treated with cold compression had an average Visual Analog Scale (VAS) pain score of 2 on the first postoperative day, which increased to 3 during exercise but decreased to 0 at discharge. Patients in the control group had a VAS pain score of 2 on the first day postop and during exercise, and a score of 0 upon discharge, according to the study, published in the Journal of Arthroplasty.

Both groups had similar ranges of motion during the first 2 days postop, which averaged 50° on the first day postop for the cold compression group and 51° on the second day postop for the control group.

However, patients treated with cold compression had a significantly better range of motion upon hospital discharge and at 3 weeks follow-up. Upon discharge, range of motion averaged 75° for cold compression patients and 63° for control patients (P=.0019).

At 3 weeks, range of motion averaged 99° for the cold compression group and 88° for the control group (P=.0045), according to the study.

Patients treated with cold compression also had a significantly shorter period of hospitalization, which averaged 4.8 days vs. 6.2 days for control patients (P<.001), the authors noted.

"The positive effects we found with cryotreatment may be explained by faster mobilization, which facilitates better muscle control with decreased pain, increased [range of motion] and decreased swelling," the authors said.

"Our present data show that patients using cold therapy achieved independent ambulation more than 1 day sooner than TKA control patients," they said, adding that using a continuous-flow cooling device may improve the effects of cold compression.

For more information:
Kullenberg B, Ylipää S, Söderlund K, Resch S. Postoperative cryotherapy after total knee arthroplasty. J Arthroplasty. 2006;21:1175-1179.