CLINICAL BIBLIOGRAPHY - CPM

103 consecutive patients undergoing TKA were studied prospectively. The first 51 patients received CPM initiated in the recovery room and the next 52 patients did not. Both groups underwent an identical physical therapy program starting onpost-operative day 1. The results at discharge showed CPM to be efficacious in increasing short-term active flexion and decreasing the need for manipulation without increasing cost.

TK-5. Beneficial Effects of Continuous Passive Motion After Total Condylar Knee Arthroplasty. D. Johnson, MD. Ann R Coll Surg Engl, November 1992, Vol. 74, No. 6.

A randomized, controlled study of post-operative use of CPM after TKR found significant increase in both early and late range knee flexion in both rheumatoid and osteoarthritic patients, significantly earlier discharge from hospital, and did notcause problems with wound healing or extension lag.

TK-7. The Value of Continuous Passive Motion in Total Knee Arthroplasty.S. Wasilewski, MD et al. Orthopaedics, March 1990, Vol. 13, No. 3.

Concludes that CPM is an effective adjunct to physical therapy in the post-operative care of total knee arthroplasty patients. The use of CPM resulted in improved wound healing, decreased incidence of thromboembolus, decreased analgesic use, shorterhospital stay, and higher overall knee score.

TK-8. Continuous Passive Motion After Total Knee Arthroplasty. Vince MD, et al. The Journal of Arthroplasty, December 1987, Vol. 2, No. 4.

Supports the use of CPM in rehabilitation after total knee arthroplasty because it allows patients to achieve ROM more quickly and comfortably. The authors also found that shorter lengths of hospital stays and decreased incidence ofthrombophlebitis were benefits of post-operative CPM use, and in addition, the choice, patients prefer to use CPM.

DVT PROPHYLAXIS

DVT-1. The Changes in Intramuscular Pressure and Femoral Vein Flow With Continuous Passive Motion, Pneumatic Compressive Stockings, and Leg Manipulations. H. von Schroeder, MD et al. Clinical Orthopaedics and Related Research,May 1991, No. 266.

States that significant increases in femoral vein flow (venous dynamics) were produced with CPM devices, and that an anatomic CPM (Sutter 9000) produced a flow that was 4 times higher than a non-anatomic CPM (Kinetec), and that the combination ofextremity elevation with concurrent motion of the knee and hip joints may play a significant role in the prevention of deep vein thrombosis.

DVT-2. See TK-7: The Value of Continuous Passive Motion in Total Knee Arthroplasty.S. Wasilewski, MD et al. Orthopaedics, March 1990, Vol. 13, No. 3.

DVT-3. See TK-8: Continuous Passive Motion After Total Knee Arthroplasty. Vince MD, et al. The Journal of Arthroplasty, December 1987, Vol. 2, No. 4.

ANTERIOR CRUCIATE LIGAMENT (ACL)

ACL-1. The Effects of Immediate Continuous Passive Motion on Pain During the Inflammatory Phase of Soft Tissue Healing Following Anterior Cruciate Ligament Reconstruction. M. McCarthy, EdD, PT, ATC, and C. Yates, MD et al. JOSPT,February 1993, Vol. 17, No. 2.

This study examined the effects of CPM on acute pain immediately after arthroscopically-assisted ACL reconstruction using bone-patella-bone autograft. The results indicate that CPM had a significant effect on the patient's need for pain medicationin the inflammatory phase of healing. Clinically, this study indicates that immediate use of CPM after ACL reconstruction facilitates rehabilitation by decreasing pain.

ACL-2. Symposium on Early Motion Following Anterior Cruciate Ligament Reconstruction. C. Yates, MD, P. Wolin, MD, and R. Hammesfahr, MD. 1991.

Three prominent sports medicine orthopaedic surgeons share their views on the importance of early motion following ACL reconstruction in this symposium sponsored by Sutter Corporation. Other benefits cited are prevention of excessive scar tissue andadhesion formation, enhanced soft tissue healing, joint surface remodeling, psychological assurance, decreased effusion, and pain control.

REHABILITATION

Re-2. Rehabilitation of the Knee. J. Steadman, MD et al. Clinics in Sports Medicine, July 1989, Vol. 8, No. 3.

This article details the scientific basis for ACL reconstruction surgical & rehabilitation protocols, & acknowledges the advantages of CPM, calling it a cardinal element of therapy. CPM benefits are stated as enhanced soft tissue & articularcartilage healing, clearance of hemarthrosis, & prevention of immobilization disease.

SHOULDER

S-2. Assessment and Management of Shoulder Stiffness: A Biomechanical Approach. P. LaStayo, MPT, CHT, R. Jaffe, OTR/L, CHT. Journal of Hand Therapy, April-June 1994.

This article discusses loss of shoulder motion, including reasons it occurs, anatomical and biomechanical considerations, and treatment methods. CPM as a low load prolonged stress (LLPS) is said to modulate pain, decrease muscle spasm, decreaseeffusion and edema, and increase synovial fluid circulation. Dr. Salter's findings that CPM stimulates healing, regenerates articular cartilage, and prevents or overcomes joint stiffness are supported.

S-4. Shoulder Rheumatoid Arthritis Associated with Chondromatosis, Treated by Arthroscopy. T. Witwity, MD et al. Arthroscopy, Vol. 7, No.2, 1991.

In this case study, CPM was used in the immediate postoperative period following arthroscopic synovectomy and removal of multiple loose bodies. The patient experienced marked relief of pain and ROM improvement after the first postoperative night,and consistent improvement over the first postoperative week.

S-5. CPM for Post-Operative Rotator Cuff Repair: A Case History. K. Flowers, PT. Continuing Care, May 1990.

Significant, rapid restoration of full passive ROM at 10 days after rotator cuff repair with biceps tendon debridement, acromioplasty, and sub-acromial bursa debridement. Early passive motion of the shoulder prevents adhesions and protects therepair. The author feels that the patient's rehabilitation course would have been significantly lengthened if the patient had been immobilized.

HAND

H-3. The Therapist's Management of Intra-Articular Fractures. L. Kearny, OTR/L, CHT, and K. Brown, OTR/L, CHT. Hand Clinics, May 1994, Vol. 10, No. 4.

This article describes proper therapeutic management of phlangeal fractures utilizing splints and continuous passive motion devices. Support is given to the CPM benefits of promotion of healing, facilitation of ROM, prevention of joint contractures,decreases in pain and edema, and was also noted to be psychologically reassuring to the anxious or painful patient. A thorough comparison of competitive hand CPM devices is made.

H-5. Early Continuous Passive Movement in Hand Surgery. J. Chow and R. Schenck, MDs. Current Surgery, March-April, 1989.

CPM is described as a valuable component of hand therapy for numerous indications such as tendon repair, resurfacing arthroplasties with perichondral grafting, and fractures of the interphlangeal and metacarpophlangeal joints. CPM has recently beenused to treat burns, reflex sympathetic dystrophy, and crush-type injuries to the hand. Use of CPM can enhance surgical results by preventing contractures, reducing edema, and maintaining motion.

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