Device or ice: the effect of consistent cooling using a device compared with intermittent cooling using an ice bag after total knee arthroplasty
- PMID: 25931653
- PMCID: PMC4403323
- DOI: 10.3138/ptc.2013-78
Device or ice: the effect of consistent cooling using a device compared with intermittent cooling using an ice bag after total knee arthroplasty
Abstract
Purpose : To determine the comparative effectiveness of consistent cooling using an icing device (DonJoy Iceman, DJO Canada, Mississauga, ON) versus intermittent cooling using an ice bag (usual care) for the first 48 hours after total knee arthroplasty (TKA). Method : A sample of 78 patients (intervention group, n=37; control group, n=34) undergoing primary TKA were randomized to intervention (device) or control (ice) groups. The primary outcome was pain intensity, measured by numerical pain rating scale (NPRS). Secondary outcomes were passive range of motion (PROM), nausea or vomiting, opioid use, blood loss, lower limb function, hospital length of stay, and patient-reported compliance and satisfaction. Results : No significant differences in the primary outcome (pain intensity measured via NPRS) were observed between control and intervention groups. Patients in the intervention group were significantly more satisfied (8.4 vs. 6.0, p=0.002); used the device more consistently, day and night (85.7% vs. 29.6% and 87.6% vs. 30.8%, respectively, p<0.001); and were more likely to recommend this method of cooling (96.8% vs. 68.0%, p=0.004). Conclusion : The study found no additional benefit of consistent cryotherapy using the icing device over intermittent ice bags on postoperative pain, PROM, nausea or vomiting, opioid use, blood loss, lower limb function, or length of stay, despite significant differences in patient-reported compliance and satisfaction.
Objet: Déterminer l'efficacité comparative du refroidissement constant au moyen d'un dispositif de refroidissement (DonJoy Iceman, DJO Canada, Mississauga, Ontario) en comparaison du refroidissement intermittent découlant de l'utilisation d'un sac à glace (soins habituels) dans les 48 premières heures suivant l'arthroplastie totale du genou. Méthode: Un échantillon de 78 patients (groupe d'intervention n=37; groupe témoin n=34) ayant subi une première arthroplastie totale du genou ont été randomisés dans des groupes d'intervention (dispositif) ou témoin (glace). Le résultat principal était l'intensité de la douleur, mesurée selon une échelle d'évaluation numérique de la douleur. Les résultats secondaires étaient l'amplitude passive du mouvement, les nausées/vomissements, l'utilisation d'opioïde, la perte de sang, la fonction des membres inférieurs, la durée du séjour à l'hôpital, et la conformité et la satisfaction déclarées par les patients. Résultats: On n'a observé aucune différence significative dans le résultat principal (intensité de la douleur mesurée selon une échelle d'évaluation numérique de la douleur) entre les groupes témoin et d'intervention. Les patients du groupe d'intervention étaient considérablement plus satisfaits (8,4 contre 6, 0, p=0,002); utilisaient le dispositif de façon plus uniforme, le jour et la nuit (85.7% contre 29.6% et 87.6% contre 30.8%, respectivement, p<0,001); et étaient plus susceptibles de recommander cette méthode de refroidissement (96,8% contre 68,0%, p=0,004). Conclusion : L'étude n'a révélé aucun avantage supplémentaire découlant de la cryothérapie constante au moyen d'un dispositif de refroidissement par rapport aux sacs à glace intermittents pour ce qui est de la douleur postopératoire, de l'amplitude passive du mouvement, des nausées/vomissements, de l'utilisation d'opioïdes, de la perte de sang, de la fonction des membres inférieurs ou de la durée du séjour, malgré les différences significatives en matière de conformité et de satisfaction déclarées par les patients.
Keywords: arthroplasty; cryotherapy; knee.
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