Evaluation of the Efficacy of Local Cryotherapy Following Total Knee Arthroplasty in the Early Postoperative Period: A Randomized Controlled Trial



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BACKGROUND: Despite the growing number of publications reporting the efficacy of local cryotherapy in reducing pain, edema, and improving function after total knee arthroplasty (TKA), systematic review data remain contradictory due to high heterogeneity in the applied techniques. This creates a need for standardization of the local cryotherapy protocol and the conduct of high-quality studies to assess its efficacy in the early postoperative period.

AIM: To evaluate the efficacy of a standardized local cryotherapy protocol, based on achieving and maintaining skin surface temperature at 10–15 °C for 30 minutes, in the early postoperative period after total knee arthroplasty.

METHODS: A prospective randomized controlled trial was conducted. Patients aged 50–70 years with stage III arthritis knee undergoing TKA were randomly assigned to two groups: the intervention group (local cryotherapy) and the control group (no cooling). Cryotherapy involved the application of a hypothermic ice device for 60 minutes, with ice pack replacement every 6 hours over 72 hours. Assessments included skin temperature, pain intensity (VAS), opioid requirement, edema progression dynamics, range of motion (ROM), blood loss, and time to meet discharge criteria.

RESULTS: Sixty-three participants were enrolled, with 60 completing the study: intervention group (n=30) and control group (n=30). The intervention group demonstrated a significant reduction in pain (p <0.004) and opioid requirement (p <0.006), lower blood loss (p <0.015), greater active (p <0.017) and passive (p <0.018) ROM. Patients in the intervention group met discharge criteria earlier by 72 hours (p <0.038). No significant differences in edema progression were found between groups (p >0.458). During cryotherapy, all patients in the intervention group achieved the target skin temperature exposure (10–15 °C) for 30±4 minutes per application.

CONCLUSIONS: The standardized protocol, based on achieving and maintaining skin surface temperature within the 10–15 °C range for 30 minutes per application, significantly reduces pain intensity, decreases opioid requirement, reduces blood loss, improves joint range of motion, and accelerates achievement of discharge criteria. Using the temperature parameter (10–15 °C skin temperature) as a target efficacy indicator ensures reproducibility and standardization of the cryotherapy technique. Further research is warranted to optimize cryotherapy parameters and conduct comparative analysis with other physical cooling methods.

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作者简介

Dmitrii Kazantsev

The Federal state-financed institution "The Federal Center of Traumatology, Orthopedics and Endoprosthetics" of The Ministry of Health of the Russian Federation (Barnaul)

编辑信件的主要联系方式.
Email: dmitry.kazantsev@inbox.ru
ORCID iD: 0000-0002-5498-3861

Orthopedic Surgeon

俄罗斯联邦, Алтайский край г. Барнаул ул. Ляпидевского 1/3, 656045

Alexandr Ochkurenko

FSBI "N.N. Priorov National Medical Research Center of Traumatology and Orthopedics" of the Ministry of Health of Russia

Email: cito@cito-priorov.ru
ORCID iD: 0000-0002-1078-9725

Doctor of Medical Sciences, Professor, Department of Traumatology and Orthopedics

俄罗斯联邦, Алтайский край г. Барнаул ул. Ляпидевского 1/3, 656045

Vladimir Peleganchuk

The Federal state-financed institution "The Federal Center of Traumatology, Orthopedics and Endoprosthetics" of The Ministry of Health of the Russian Federation (Barnaul)

Email: 297501@mail.ru
ORCID iD: 0000-0002-2386-4421

Chief Physician of the Federal Center for Traumatology, Orthopedics and Endoprosthetics (Barnaul) of the Ministry of Health of the Russian Federation, Head and Professor of the Department of Traumatology, Orthopedics and Vertebrology of the Altai State Medical University (ASMU) of the Ministry of Health of the Russian Federation

俄罗斯联邦, Алтайский край г. Барнаул ул. Ляпидевского 1/3, 656045

Yurii Batrak

The Federal state-financed institution "The Federal Center of Traumatology, Orthopedics and Endoprosthetics" of The Ministry of Health of the Russian Federation (Barnaul)

Email: 297501@mail.ru
ORCID iD: 0000-0003-0489-1480

Cand. Sci. (Med.), Deputy Chief Medical Officer of "The Federal state-financed institution "The Federal Center of Traumatology, Orthopedics and Endoprosthetics" of The Ministry of Health of the Russian Federation (Barnaul)

俄罗斯联邦, Алтайский край г. Барнаул ул. Ляпидевского 1/3, 656045

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