Effectiveness and methods of cryotherapy in reducing swelling after total knee arthroplasty: A systematic review on randomized controlled trials

The role of tranexamic acid and cryotherapy on acute postoperative pain and blood loss: a randomized controlled study following total knee arthroplasty

PURPOSE

Blood loss and pain management are significant concerns in total knee arthroplasty (TKA). Tranexamic acid (TA) and cryotherapy have been used separately to address these issues, but their comparative effectiveness is not well studied. This study aimed to evaluate the efficacy of intravenous TA and cryotherapy in reducing blood loss and improving clinical outcomes after TKA.

METHODS

A randomized controlled trial with 76 patients assigned to three groups: Group 1 received pre- and postoperative cryotherapy, Group 2 received intravenous tranexamic acid (TA), and Group 3 (control) received a standard cold pack. Hemoglobin (Hb), hematocrit (Hct), prothrombin time, international normalized ratio (INR), knee flexion and extension angles, and visual analog scale (VAS) pain scores were monitored preoperatively and postoperatively at 6, 24, and 48 h.

RESULTS

The mean age of patients was 65 ± 7 years. The tranexamic acid group showed significantly lower blood loss compared to the control group (p < 0.001). Knee flexion and extension angles were significantly better in the cryotherapy group compared to the control group (p < 0.001). VAS pain scores were significantly lower in the cryotherapy group at all time points compared to both the tranexamic acid and control groups (p < 0.001).

CONCLUSION

Both tranexamic acid and cryotherapy are effective in reducing blood loss and improving clinical outcomes following TKA. Tranexamic acid significantly reduces blood loss, while cryotherapy effectively manages postoperative pain and range of motion. These methods can enhance patient recovery after TKA.

Comparison of three cryotherapy techniques for early post-TKA pain control in terms of efficacy and patient satisfaction: a randomized controlled trial

BACKGROUND

Cryotherapy is a non-pharmacological option that complements drug therapy to achieve the most comprehensive multimodal analgesia. Various techniques are currently available, including the conventional gel cold pack, the cryo-cuff, and a novel mobile cold compression device (MCCD). This study aimed to evaluate and compare three cryotherapy techniques in terms of efficacy and patient satisfaction in patients undergoing total knee arthroplasty (TKA).

METHODS

This prospective randomized study included 108 patients who were scheduled for primary unilateral TKA. The patients were allocated to 3 groups for postoperative cryotherapy techniques: gel cold pack, cryo-cuff, and MCCD. Scores on the visual analog scale (VAS) for pain intensity, morphine consumption, knee range of motion (ROM), knee swelling, length of hospital stay, and patient satisfaction were collected.

RESULTS

Postoperative VAS scores showed a significant difference among the groups at 8 and 72 h after surgery (P = 0.002 and 0.026, respectively). At the earliest postoperative time point, post hoc analysis demonstrated that patients in the MCCD group had lower pain scores than those in the gel cold pack (P < 0.001) and the cryo-cuff group (P = 0.030). However, cryo-cuff reduced knee swelling significantly compared to gel cold pack (P = 0.028) and MCCD (P = 0.011) at postoperative 72 h. The total satisfaction score was 86.8, 82.8, and 89.1 with gel cold pack, cryo-cuff, and MCCD, respectively.

CONCLUSIONS

Cryotherapy is an adjunct to post-TKA pain control at the surgical site. MCCD has shown superior efficacy in pain reduction during the earliest postoperative period, and achieved high patient satisfaction.

TRIAL REGISTRATION

This study was registered in the Thai Clinical Trials Registry database (no. TCTR20200517002).

Application of multifunctional pulse wave sphygmomanometer combined with constant temperature ice in patients with forearm hematoma after coronary intervention

AIM

This study aims to investigate the effects of combining a multifunctional pulse wave sphygmomanometer with constant temperature ice on patients with forearm hematoma following coronary intervention.

METHODS

Patients who developed forearm hematoma after undergoing coronary intervention from March 2021 to March 2023 at our hospital were selected as the study cohort. Using a random number table, they were divided into two groups the control group and the research group. The control group received cuff compression treatment using a multifunctional pulse wave sphygmomanometer. The primary endpoint was the effective rate of one compression. Secondary endpoints included body surface temperature, pain, comfort, arm measurements, and swelling value.

RESULTS

A total of 190 patients were included, with 95 in the control group and 95 in the research group. The research group showed a significantly higher effective rate of one compression compared to the control group (87.2% vs. 95.8%, p = 0.035). Additionally, the research group experienced significantly reduced pain (2.0 [2.0,3.0] vs. 1.0 [1.0,2.0], p < 0.001) and improved comfort levels. This approach also effectively reduced body surface temperature (32.91 ± 0.83℃ vs. 12.09 ± 1.09℃, p < 0.001), arm measurements (274.32 ± 9.56 mm vs. 271.15 ± 8.82 mm, p = 0.019), and swelling value (12.40 ± 1.95 vs. 11.07 ± 2.13, p < 0.001) after compression.

CONCLUSIONS

The combined use of a multifunctional pulse wave sphygmomanometer for cuff compression on forearm hematoma with simultaneous constant temperature ice application demonstrated more benefits. This approach effectively reduced pain, improved comfort levels, and enhanced compression-based hemostasis and reduction of swelling.

TRIAL REGISTRATION

Ethics No.KY20210604-02-KS-01.

Cryotherapy for Rehabilitation After Total Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis

OBJECTIVE

Despite being well-studied and widely utilized, the efficacy of cryotherapy after total knee arthroplasty (TKA) in enhancing early rehabilitation lacks consensus. The aim of this systematic review and meta-analysis was to investigate (1) whether cryotherapy is able to promote the rehabilitation of patients undergoing TKA and (2) whether continuous cold flow device has superior results than cold pack in cryotherapy.

METHODS

A comprehensive trial searching was performed in the PubMed, Embase, Cochrane Library, and Google Scholar electronic databases in May, 2024. Randomized controlled trials (RCTs) comparing cryotherapy with no cryotherapy or comparing continuous cold flow device with cold pack after TKA were included. The primary outcome was visual analogue scale (VAS) of pain, and secondary outcomes included opioid consumption, blood loss (hemoglobin decrease and drainage), range of motion (ROM), swelling, length of stay (LOS), and adverse event.

RESULTS

A total of 31 RCTs were included in this meta-analysis with 18 trials comparing cryotherapy with no cryotherapy and 13 trials comparing continuous cold flow device with cold pack. Pooled results showed cryotherapy group had significantly lower VAS scores than no cryotherapy group on postoperative day (POD) 1 (MD, -0.59 [95% CI, -1.14 to -0.04]; p = 0.04), POD 2 (MD, -0.84 [95% CI, -1.65 to -0.03]; p = 0.04), and POD 3 (MD, -0.86 [95% CI, -1.65 to -0.07]; p = 0.03). Cryotherapy group also showed reduced opioid consumption, reduced hemoglobin loss, decreased drainage, and improved ROM after TKA. Continuous cold flow device group had comparable VAS, opioid consumption, blood loss, ROM, knee swelling, and LOS with cold pack group.

CONCLUSION

Cryotherapy can effectively alleviate postoperative pain, reduce blood loss, improve ROM, and thus promote the postoperative rehabilitation for TKA patients, but the continuous cold flow device did not show better efficacy than cold packs. These findings support the routine use of cryotherapy for the rapid rehabilitation of TKA patients, and the traditional cold pack is still recommended.

Randomized controlled trial of compressive cryotherapy versus standard cryotherapy after total knee arthroplasty: pain, swelling, range of motion and functional recovery

BACKGROUND

After total knee arthroplasty (TKA), patients have limited knee range of motion (ROM), trophic changes and pain. Cryotherapy and compression are recommended in the literature, but no study has shown that cryotherapy and compression combined leads to better results than cryotherapy alone. The primary objective was to compare knee ROM after 21 days of rehabilitation post-TKA between patients who underwent rehabilitation with compressive cryotherapy with those who had cryotherapy alone. The secondary objectives were to compare other trophic, pain and functional outcomes.

METHODS

Forty patients were randomized into two groups: Standard Cryotherapy (SC = 20, median age 77 years), which applied cold packs along with their rehabilitation; and Compressive Cryotherapy (CC = 20, median age 76 years), which received cold compression. Knee joint's passive and active ROM (primary outcome) were measured with a goniometer. Knee's circumference, fluctuation test, pain at rest and during activity, 6-minute walking test (6MWT) and KOOS questionnaire were secondary outcomes. The groups were compared on D1 (baseline) and D21 of rehabilitation. A survival analysis has compared the groups on D1, D8, D15, D21.

RESULTS

All subjects had a significant improvement in all the parameters on D21 relative to D1 (p < .05), except for pain at rest (p = .065 for CC and p = .052 for SC). On D21, the CC group had a significantly larger improvement in the joint effusion (p = .002), pain during activity (p = .005), 6MWT (p = .018) and KOOS (p = .004) than the SC group. Based on the survival analysis, the CC group had significantly faster improvement in the joint ROM (p = .011 for flexion and p = .038 for extension) and knee circumference (p = .013) than the SC group.

CONCLUSIONS

Both cryotherapy methods improved joint ROM, trophic changes, pain and function. Adding dynamic compression to a cryotherapy protocol provided further benefits: a significantly faster improvement in passive knee flexion ROM, a greater reduction of swelling, and pain during activity. Similarly, walking distance and KOOS questionnaire were significantly better for CC.

TRIALS REGISTRATION

The study was registered in the ClinicalTrials.gov database on 14/09/2023 (identifier: NCT06037824).