Clinical Comparative Study between Modified Drop and Dangle Exercise and Continuous Passive Motion Machine to Increase Flexion after Total Knee Replacement

Main Article Content

ดวงรักษ์ สวัสดิ์ภาพ
อนุวัตร พงษ์คุณากร

Abstract

Background: Postoperative total knee replacement (TKR) exercise with early passive flexion, namely ‘drop and dangle protocol’, had been proposed to increase range of motion (ROM) as effective as with using a continuous passive motion machine (CPM). This technique was modified and implemented in Lampang Hospital.
Objective: To compare outcome of modified ‘drop and dangle’ exercise and 3-hours daily CPM for increasing knee flexion following primary TKR.
Material and method: A historical controlled-trial was conducted on the patients who underwent  unilateral TKA in Lampang Hospital from December 2007 to November 2009 (control group, n=41) and from December 2009 to December 2011 (study group, n=41) by the same surgeon and prosthesis design. Postoperatively the leg in study group was placed into the knee immobilizer in 70° flexion and removed in postoperative day 1. ROM exercise was started by bedside dropping the leg, dangling and passively bending the knee to achieve maximal flexion by the help of opposite foot. The leg in control group was splinted with Jones bandage in full extension, then placed onto CPM machine in the next day. Both groups consumed three 1-hour sessions per day. Pre-and-postoperative clinical data were prospectively collected in study group and retrospectively reviewed in control group. The outcomes were compared by using exact probability test and Wilcoxon’s rank-sum test.
Results: Preoperatively, patients’ characteristics were similar in both groups. Postoperatively, the study group had less time to achieve 90° of flexion (3.1 vs 3.5 days, p=0.237) and higher passive flexion at discharge but not statistically significant (100.9° vs 97.6°, p=0.078). At 6-week followup, no significant difference of knee flexion was detected between the control and study group (104.2° vs 101.3°, p=0.161), including at 1-year (110.6° vs 112.3°, p=0.814) and 3-year
(112.4° vs 114.0°, p=0.892). ROM achieved from 3-hours daily use of CPM was comparable to those obtained from different daily duration of CPM use in previous studies.
Conclusion: Modified drop and dangle exercise could increase knee flexion after TKR as high as use of CPM during admission, at 6-week, 1-year and 3-year follow-up. For patients exempted to this exercise, only 3-hours daily use of CPM can regain flexion motion comparably to longer daily duration of application.

Downloads

Download data is not yet available.

Article Details

How to Cite
สวัสดิ์ภาพ ด., & พงษ์คุณากร อ. (2015). Clinical Comparative Study between Modified Drop and Dangle Exercise and Continuous Passive Motion Machine to Increase Flexion after Total Knee Replacement. Lampang Medical Journal, 36(1), 14–25. Retrieved from https://he01.tci-thaijo.org/index.php/LMJ/article/view/186428
Section
Original Article

References

1. Chiu KY, Ng TP, Tang WM, Yau WP. Review article: knee flexion after total knee arthroplasty. J Orthop Surg (Hong Kong) 2002;10(2):194-202.
2. Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, et al. Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. J Rheumatol 2004; 31(11):2251-64.
3. Mulholland SJ, Wyss UP. Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants. Int J Rehabil Res 2001;24:191-8.
4. Schurman DJ, Rojer DE. Total knee arthroplasty: range of motion across five systems. Clin Orthop Relat Res 2005;430:132-7.
5. Milne S, Brosseau L, Robinson V, Noel MJ, Davis J, Drouin H, Wells G, Tugwell P: Continuous passive motion following total knee arthroplasty. Cochrane Database Syst Rev 2003:CD004260.
6. Kumar PJ, McPherson EJ, Dorr LD, Wan Z, Baldwin K. Rehabilitation after total knee arthroplasty: a comparison of 2 rehabilitation techniques. Clin Orthop Relat Res 1996;331:93-101.
7. Lenssen AF, van Dam EM, Crijns YH, Verhey M, Geesink RJ, van den Brandt PA, et al. Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. BMC Musculoskelet Disord 2007;8:83.
8. Rowe PJ, Myles CM, Walker C, Nutton R. Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?. Gait Posture 2000;12:143-55.
9. Eyring EJ, Murray WR. The effect of joint position on the pressure of intra-articular effusion. J Bone Joint Surg Am 1964;46A:1235-41.
10. O’Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev 2000;37:179-88.
11. Meylan N, Elia N, Lysakowski C, Tramer MR. Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaesth 2009;102(2):156-67.
12. Harms M, Engstrom B. Continuous passive motion as an adjunct to treatment in the physio therapy management of the total knee arthroplasty patient. Physiotherapy 1991;7:301-7.
13. Nielsen PT, Rechnagel K, Nielsen SE. No effect of continuous passive motion after total knee arthroplasty of the knee. Acta Orthop Scand 1988;59(5):580-1.
14. Ritter MA, Gandolf VS, Holston KS. Continuous passive motion versus physical therapy in total knee arthroplasty. Clin Orthop Relat Res 1989;244:239-43.
15. Montgomery F, Eliasson M. Continuous passive motion compared to active physical therapy after total knee arthroplasty: similar hospitalization times in a randomized study of 68 patients. Acta Orthop Scand 1996;67:7-9.
16. Chiarello CM, Gundersen L, O’Halloran T. The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. J Orthop Sports Phys Ther 1997;25(2):119-27.
17. Worland RL, Arredondo J, Angles F, Jimenez FL, Jessup DE. Home continuous passive motion machine versus professional physical therapy following total knee replacement. J Arthroplasty 1998;13(7):784-7.
18. Lenssen TA, van Steyn MJ, Crijns YH, Waltje EM, Roox GM, Geesink RJ, et al. Effectiveness of prolonged use of continuous passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskelet Disord 2008;9:60.
19. MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW, Kramer John, Vaz M. Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty. Clin Orthop Relat Res 2000;380:30-5.
20. Leach W, Reid J, Murphy F. Continuous passive motion following total knee replacement: a prospective randomized trial with follow-up to 1 year. Knee Surg Sports Traumatol Arthrosc 2006;14(10):922-6.
21. Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev 2014;2:CD004260. doi: 10.1002/14651858. CD004260.pub3.