This prospective randomised study compared the outcomes of patients undergoing total knee arthroplasty who received a single intraoperative dose of local anaesthetic and adrenaline and had different postoperative continuous passive motion (CPM) protocols. 55 patients were randomised prior to surgery into two treatment groups. Nine patients were excluded because they did not return for three month follow-up, six patients were excluded because an epidural was commenced in theatre and two were excluded because they did not receive the intra-articular injection. This left 18 patients in Group A and 20 patients in Group B. Group A had 48 hours of continuous CPM and Group B did not have routine CPM. If patients in Group B had less than 70 degrees of active-assisted knee flexion they received one hour per day of CPM. Two patients in group B required the CPM and the remaining 18 patients in Group B did not have any CPM. At four days post-operatively Group B had significantly more knee extension then Group A but at three months post-operatively there was no significant difference between groups. At four days and three months post-operatively no significant difference was found between groups in knee flexion or quadriceps lag. There was also no significant difference between the two groups for length of stay, quality of life, need for a manipulation under anaesthetic or requirement of a blood transfusion. The 48 hour CPM group had significantly more blood loss in the drain (p=0.009) and experienced more pain measured by the need for an intervention on the ward due to pain (p=0.036). These results show that continuous CPM for 48 hours had no advantage in improving range of motion, length of stay or quality of life and that it increased blood loss and caused more pain.
|Publication status||Unpublished - 2013|