Total knee Replacement


Effect of cryotherapy, emotional support, and exercises on mobility after total knee replacement



Total knee replacement (TKR) is one of the most common surgical procedures to rectify the pain associated with joints and has been predicted to be increased (Kurtz et al., 2007) in future. Following TKR, patients frequently experience intense levels of pain, stress, and anxiety that may reduce their self-efficacy and thus affect their postoperative recovery. The intent of TKR is to provide relief from chronic pain and improve function. However, most patients experience chronic post-surgical pain. To control pain perception, centrally acting pain suppressants such as opioid-based drugs can be given by the epidural route and is popularly known as patient-controlled analgesia (PCA) (ASATF, 2012). The drugs act centrally by binding to receptors, named mu, kappa, sigma, delta, and epsilon. Continuous infusion of morphine as a part of PCA can cause respiratory depression therefore the patients have to be carefully monitored. To avoid such adverse events it would be desired to use alternative therapies such as cryotherpy. Therefore, it was aimed to describe the alternative modes of therapy in TKR to improve the mobility of patients with TKR and reduce the pain perception.

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Cryotherapy (use of cold utilities, ice bags or cooled water) promotes vasoconstriction, and reduces the tissue trauma after surgery thereby it minimizes the extent of tissue trauma after knee surgery (Adie et al., 2009). However researchers opined that the use of ice alone show swelling due cold induced ischemic damage to blood vessels and recommending using simultaneously the application of cold and compression (Kullenberg et al., 2006). Cryotherapy offers pain suppression similar to that of PCA (Holmstrom, & Hardin, 2005), so the administration of morphine can be avoided. From the evidences, it can be understood that the cold alone not suffices to improve the range of motion. Both cold and compression appears to be showing an improvement of range of motion (Markert, 2011). Despite the overwhelming success of TKR, functional improvement after surgery varies widely. Poor functional results have been associated with poor emotional health, such as anxiety, depression, poor coping skills, and poor social support (Ayers et al., 2005). The patients who are at risk of having less functional improvement after orthopaedic surgery can be identified preoperatively. Accordingly, support would be extended to increase the level of confidence so that the patients with TKR are recovered easily. The heath care team of clinicians, physical therapists, behavioral psychologists, and other support professionals involves in providing the emotional support. The rehabilitation, with an accentuation on physiotherapy and exercise, is broadly promoted mode of intervention after TKR with varying content and duration. According to the randomized controlled trail, the physical exercise or physiotherapy had showed an improvement in physical function (Evgeniadis et al., 2008). It indicates that the physiotherapy exercise influences the recovery and mobility of the patients. In case of exercise as the intervention, it is desired to know content and duration of physiotherapy exercise for the improvement of short and long-term outcomes. In conclusion, diverse modes of interventions are available for the recovery and suppression of pain after TKR.

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  • Adie, S., Naylor, J. M., & Harris, I. A. (2009). Cryotherapy after total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. The Journal of Arthroplasty, 25(5), 709–715.

  • ASATF (2012). Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology, 116(2), 248-273.

  • Ayers, D.C., Franklin, P.D., Ploutz-Snyder, R & Boisvert, C.B (2005). Total knee replacement outcome and coexisting physical and emotional illness. Clin Orthop Relat Res. (440), 157-61

  • Evgeniadis, G., Beneka, A., Malliou, P., Mavromoustakos, S & Godolias, G (2008). Effects of pre- or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis. J Back Musculoskelet. 21(3), 161-9

  • Holmstrom, A., & Hardin, B. C. (2005). Cryo/Cuff compared to epidural anesthesia after knee unicompartmental arthroplasty: A prospective, randomized, and controlled study of 60 patients with a 6-week follow-up. The Journal of Arthroplasty, 20(3), 316–321.

  • Kullenberg, B., Ylipaa, S., Soderlund, K., & Resch, S. (2006). Postoperative cryotherapy after total knee arthroplasty: A prospective study of 86 patients. The Journal of Arthroplasty, 21(8), 1175–1179.

  • Kurtz, S., Ong, K., Lau, E., Mowat, F & Halpern, M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89-A, 780–785.

  • Markert, S.E (2011). The use of cryotherapy after a total knee replacement: a literature review. Orthop Nurs. 30(1), 29-36. doi: 10.1097/NOR.0b013e318205749a.

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