Continuous Passive Motion After Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Associated Effects on Clinical Outcomes

Published:March 02, 2019DOI:



      To evaluate the efficacy of continuous passive motion (CPM) after total knee arthroplasty (TKA) and whether the use of CPM is related to improved clinical and functional outcomes.

      Data Sources

      A systematic MEDLINE search via Web of Science, Cochrane Library, and PubMed databases was conducted.

      Study Selection

      English-language articles published between January 2000 and May 2018 reporting the related clinical outcomes of CPM after TKA were included. A total of 3334 titles and abstracts were preliminarily reviewed, of which 16 studies were included according to the eligibility criteria.

      Data Extraction

      Two different reviewers were selected to perform the study extraction, independent of each other. If there were any disagreements regarding the final list of studies, the third reviewer reviewed the list as an arbitrator for completeness.

      Data Synthesis

      A total of 16 trials with 1224 patients were included. The pooled results revealed that use of CPM did not show a statistically significant improvement of postoperative knee range of motion (ROM) except for middle-term passive knee extension and long-term active knee flexion ROM. Also, CPM therapy did not show a significant positive effect on the functional outcomes. No significant reduction in length of stay (LOS) and incidence of adverse events (AEs) was identified.


      Among patients undergoing TKA, neither the ROM nor the functional outcomes could be improved by CPM therapy. Moreover, the risk of AEs and LOS could not be reduced by application of CPM. The current available evidence suggested that this intervention was insufficient to be used routinely in clinical practice.


      List of abbreviations:

      AE (adverse event), CPM (continuous passive motion), LOS (length of stay), KSS (Knee Society Score), WMD (weighted mean difference), OA (osteoarthritis), RA (rheumatoid arthritis), ROM (range of motion), TKA (total knee arthroplasty), TUG (timed Up and Go), WOMAC (Western Ontario and McMaster University Osteoarthritis Index)
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        • Rex C.
        Continuous passive motion therapy after total knee arthroplasty.
        Nursing. 2018; 48: 55-57
        • Chaudhry H.
        • Bhandari M.
        Cochrane in CORR (®): continuous passive motion following total knee arthroplasty in people with arthritis (review).
        Clin Orthop Relat Res. 2015; 473: 3348-3354
        • Rowe P.J.
        • Myles C.M.
        • 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: 143-155
        • Liao C.D.
        • Huang Y.C.
        • Lin L.F.
        • et al.
        Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2578-2586
        • Stratford P.W.
        • Kennedy D.M.
        • Robarts S.F.
        Modelling knee range of motion post arthroplasty: clinical applications.
        Physiother Can. 2010; 62: 378-387
        • Bjerke J.
        • Ohberg F.
        • Nilsson K.G.
        • Foss O.A.
        • Stensdotter A.K.
        Peak knee flexion angles during stair descent in TKA patients.
        J Arthroplasty. 2014; 29: 707-711
        • Bade M.J.
        • Kittelson J.M.
        • Kohrt W.M.
        • Stevens-Lapsley J.E.
        Predicting functional performance and range of motion outcomes after total knee arthroplasty.
        Am J Phys Med Rehabil. 2014; 93: 579-585
        • Naylor J.M.
        • Ko V.
        • Rougellis S.
        • et al.
        Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2.
        J Eval Clin Pract. 2012; 18: 652-658
        • Harvey L.A.
        • Brosseau L.
        • Herbert R.D.
        Continuous passive motion following total knee arthroplasty in people with arthritis.
        Cochrane Database Syst Rev. 2014; 2: CD004260
        • Chen L.H.
        • Chen C.H.
        • Lin S.Y.
        • et al.
        Aggressive continuous passive motion exercise does not improve knee range of motion after total knee arthroplasty.
        J Clin Nurs. 2013; 22: 389-394
        • Insall J.N.
        • Dorr L.D.
        • Scott R.D.
        • Scott W.N.
        Rationale of the Knee Society clinical rating system.
        Clin Orthop Relat Res. 1989; : 13-14
        • Bruun-Olsen V.
        • Heiberg K.E.
        • Mengshoel A.M.
        Continuous passive motion as an adjunct to active exercises in early rehabilitation following total knee arthroplasty - a randomized controlled trial.
        Disabil Rehabil. 2009; 31: 277-283
        • Lingard E.A.
        • Katz J.N.
        • Wright R.J.
        • Wright E.A.
        • Sledge C.B.
        • Kinemax Outcomes Group
        Validity and responsiveness of the Knee Society clinical rating system in comparison with the SF-36 and WOMAC.
        J Bone Joint Surg Am. 2001; 83: 1856-1864
        • Podsiadlo D.
        • Richardson S.
        The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Mancuso C.A.
        • Ranawat A.S.
        • Meftah M.
        • Koob T.W.
        • Ranawat C.S.
        Properties of the patient administered questionnaires: new scales measuring physical and psychological symptoms of hip and knee disorders.
        J Arthroplasty. 2012; 27: 575
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Chen B.
        • Zimmerman J.R.
        • Soulen L.
        • DeLisa J.A.
        Continuous passive motion after total knee arthroplasty: a prospective study.
        Am J Phys Med Rehabil. 2000; 79: 421-426
        • MacDonald S.J.
        • Bourne R.B.
        • Rorabeck C.H.
        • McCalden R.W.
        • Kramer J.
        • Vaz M.
        Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty.
        Clin Orthop Relat Res. 2000; : 30-35
        • Beaupré L.A.
        • Davies D.M.
        • Jones C.A.
        • Cinats J.G.
        Exercise combined with continuous passive motion or slider board therapy compared with exercise only: a randomized controlled trial of patients following total knee arthroplasty.
        Phys Ther. 2001; 81: 1029-1037
        • Can F.
        • Alpaslan M.
        Continuous passive motion on pain management in patients with total knee arthroplasty.
        Pain Clin. 2003; 15: 479-485
        • Huang D.S.
        • Peng Y.
        • Su P.Q.
        • Ye W.
        • Liang A.J.
        The effect of continuous passive motion after total knee arthroplasty on joint function.
        Chin J Clin Rehabil. 2003; 7: 1661-1662
        • Bennett L.A.
        • Brearley S.C.
        • Hart J.A.
        • Balley M.J.
        A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study.
        J Arthroplasty. 2005; 20: 225-233
        • Denis M.
        • Moffet H.
        • Caron F.
        • Ouellet D.
        • Paquet J.
        • Nolet L.
        Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial.
        Phys Ther. 2006; 86: 174-185
        • Lenssen T.A.
        • van Steyn M.J.
        • Crijns Y.H.
        • 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
        • Alkire M.R.
        • Swank M.L.
        Use of inpatient continuous passive motion versus no CPM in computer-assisted total knee arthroplasty.
        Orthop Nurs. 2010; 29: 36-40
        • Maniar R.N.
        • Baviskar J.V.
        • Singhi T.
        • Rathi S.S.
        To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery.
        J Arthroplasty. 2012; 27: 193-200
        • Herbold J.A.
        • Bonistall K.
        • Blackbum M.
        • et al.
        Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement.
        Arch Phys Med Rehabil. 2014; 95: 1240-1245
        • Boese C.K.
        • Weis M.
        • Phillips T.
        • Lawton-Peters S.
        • Gallo T.
        • Centeno L.
        The efficacy of continuous passive motion after total knee arthroplasty: a comparison of three protocols.
        J Arthroplasty. 2014; 29: 1158-1162
        • Joshi R.N.
        • White P.B.
        • Murray-Weir M.
        • Alexiades M.M.
        • Sculco T.P.
        • Ranawat A.S.
        Prospective randomized trial of the efficacy of continuous passive motion post total knee arthroplasty: experience of the hospital for special surgery.
        J Arthroplasty. 2015; 30: 2364-2369
        • Baloch N.
        • Zubairi A.J.
        • Rashid R.H.
        • Hashmi P.M.
        • Lakdawala R.H.
        Effect of continuous passive motion on knee flexion range of motion after total knee arthroplasty.
        J Pak Med Assoc. 2015; 65: S32-S34
        • Salter R.B.
        Continuous passive motion: from origination to research to clinical applications.
        J Rheumatology. 2004; 31: 2104-2105
        • Brosseau L.
        • Milne S.
        • Wells G.
        • et al.
        Efficacy of continuous passive motion following total knee arthroplasty: a meta-analysis.
        J Rheumatology. 2004; 31: 2251-2264
        • Konrad A.
        • Tilp M.
        Increased range of motion after static stretching is not due to changes in muscle and tendon structures.
        Clin Biomech (Bristol, Avon). 2014; 29: 636-642
        • Matsuzaki T.
        • Yoshida S.
        • Kojima S.
        • Watanabe M.
        Influence of ROM exercise on the joint components during immobilization.
        J Phys Ther Sci. 2013; 25: 1547-1551
        • Roorda L.D.
        • Jones C.A.
        • Waltz M.
        • et al.
        Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty.
        Ann Rheum Dis. 2004; 63: 36-42
        • Ouellet D.
        • Moffet H.
        Locomotor deficits before and two months after total knee arthroplasty.
        Arthr Rheum. 2002; 47: 484-493
        • Frank C.
        • Akeson W.H.
        • Woo S.L.-Y.
        • Amiel D.
        • Coutts R.D.
        Physiology and therapeutic value of passive joint motion.
        Clin Orthop. 1984; : 113-125
        • Johnson D.P.
        The effect of continuous passive motion on wound healing and joint mobility after knee arthroplasty.
        J Bone Joint Surg Am. 1990; 72: 421-426
        • Block J.
        • Westiake S.
        • Meredith L.
        Total knee arthroplasty: the effect of early discharge on outcome at 6-8 weeks postoperative.
        Physiother Can. 1999; 51: 45-51