Continuous passive motion as an adjunct therapy for tenolysis

A model was developed to evaluate continuous passive motion as an adjunct to tenolysis. The use of continuous passive motion after tenolysis was associated with a significant increase in tendon rupture and the terminal force necessary to flex the phalanx actively. Also, there was a decrease in the passive range of motion in the continuous passive motion group which appeared to be the result of increased granulation tissue which formed around tenolysed tendon.     

Continuous passive motion compared to active physical therapy after knee arthroplast:Similar hospitalization times in a randomized study of 68 patients

68 consecutive patients who had primary knee arthroplasties because of arthrosis were randomized to postoperative continuous passive motion (CPM) or active physical therapy (APT). Rehabilitation in both groups was initiated on the first postoperative day. The CPM group sustained less postoperative knee swelling with more rapid initial improvement in knee flexion than did the APT group, but there were no differences between the groups in knee flexion at discharge. Postoperative pain rating and hospitalization times were similar in the two groups.     

Continuous passive motion after total knee arthroplasty

Sixty-two patients undergoing primary total knee arthroplasty were studied prospectively. There were 42 patients in whom continuous passive motion (CPM) was used after surgery and 20 controls. The two groups were comparable with respect to age, diagnosis, sex, weight, and preoperative deformity and motion. The mean length of time required for CPM patients to achieve 90 degrees of flexion (9.1 days) was shorter than that for the control group (13.8 days). At the time of discharge from the hospital, however, there was no significant difference between the groups in amount of either flexion or extension. All patients had venograms performed after arthroplasty; the incidence of positive studies indicating thrombophlebitis was 45% in CPM patients and 75% in controls. These data demonstrate that CPM after knee arthroplasty enables patients to recover motion more quickly and affords some protection against deep vein thrombosis.     

Continuous passive motion versus physical therapy in total knee arthroplasty

To determine the justification of a continuous passive motion machine in the treatment of postoperative total knee arthroplasties, a comparative study of 50 consecutive patients with simultaneous bilateral total knee arthroplasties was undertaken. The patients served as their own controls because one randomly selected knee was placed in the machine while the remaining knee was treated with physical therapy only. There was no significant difference in the range of motion during the eight days of hospitalization or the follow-up visits at two weeks, two months, six months, and one year. There was a significant decrease in the swelling about the knee. The continuous passive motion treated knees appeared to be generally weaker as revealed by more extensor lags and flexor tightness at discharge from the hospital. Also, increased costs incurred from the need for additional equipment and increased staff time made the machine neither cost-effective nor beneficial.     

Results of flexor tendon tenolysis after replantation in the hand

Thirty-seven replanted digital units and four thumb replantations had a flexor tendon tenolysis at an average of 10 months after replantation. The results were assessed by measuring total active motion, potential active motion, and by the formula of Strickland and associates. The total active motion increased from a mean pretenolysis of 72 degrees to 130 degrees. The potential active motion increased from a mean of 43% to 70% after tenolysis. Both of these improvements were statistically significant (p less than 0.001). The formula of Strickland and associates rated 13 excellent, 11 good, 6 fair, and 11 poor. The thumbs had two fair results and two poor results. Poor results were also seen in crush or avulsion amputations, hands with more than two digits amputated, and those requiring a proximal interphangeal joint capsulotomy. Little difference was found related to the number of arteries or tendons repaired. Complications included tendon rupture and infection. No digits were lost. The results of this study would support flexor tendon tenolysis after replantation of fingers but not replanted thumbs.     

Continuous passive motion after knee-joint arthrolysis under catheter peridural anesthesia

The results of arthrolysis of a stiff knee are often poor because postoperative pain prevents the early active mobilization that is so essential. Adequate analgesia may be ensured by the use of continuous anesthesia via a peridural catheter; in combination with continuous passive motion, such analgesia is able to maintain, and often improve, the range of movement obtained at surgery. Twenty-two patients treated in this way showed improvement in the range of movement between 39 degrees and 120 degrees. Patients with post-traumatic knee stiffness achieved an average improvement in the range of movement of 93%, while those with stiffness following infection improved by only 55% on the average. The preoperative loss of movement does not appear to determine the end result; the etiology of the stiffness is more important.     

Continuous passive motion after knee-joint arthrolysis under catheter peridural anesthesia

Summary The results of arthrolysis of a stiff knee are often poor because postoperative pain prevents the early active mobilization that is so essential. Adequate analgesia may be ensured by the use of continuous anesthesia via a peridural catheter; in combination with continuous passive motion, such analgesia is able to maintain, and often improve, the range of movement obtained at surgery. Twenty-two patients treated in this way showed improvement in the range of movement between 39° and 120°. Patients with post-traumatic knee stiffness achieved an average improvement in the range of movement of 93%, while those with stiffness following infection improved by only 55% on the average. The preoperative loss of movement does not appear to determine the end result; the etiology of the stiffness is more important.     

Continuous passive motion in the prevention of deep-vein thrombosis: a randomised comparison in trauma patients

There is a high risk of venous thromboembolism when patients are immobilised following trauma. The combination of low-molecular-weight heparin (LMWH) with graduated compression stockings is frequently used in orthopaedic surgery to try and prevent this, but a relatively high incidence of thromboembolic events remains. Mechanical devices which perform continuous passive motion imitate contractions and increase the volume and velocity of venous flow.In this study 227 trauma patients were randomised to receive either treatment with the Arthroflow device and LMWH or only with the latter. The Arthroflow device passively extends and plantarflexes the feet. Patients were assessed initially by venous-occlusion plethysmography, compression ultrasonography and continuous wave Doppler, which were repeated weekly without knowledge of the category of randomisation. Those who showed evidence of deep-vein thrombosis underwent venography for confirmation. The incidence of deep-vein thrombosis was 25% in the LMWH group compared with 3.6% in those who had additional treatment with the Arthroflow device (p < 0.001). There were no substantial complications or problems of non-compliance with the Arthroflow device. Logistic regression analysis of the risk factors of deep-vein thrombosis showed high odds ratios for operation (4.1), immobilisation (4.3), older than 40 years of age (2.8) and obesity (2.2).     

Continuous passive motion following flexor tendon repair

A prospective study was performed of 20 consecutive patients with 35 flexor tendon lacerations, in whom post-operative mobilisation was carried out using the Toronto Mobilimb Continuous Passive Motion machine for the first 4 1/2 weeks. Overall the results assessed by Buck Gramcko criteria were 17 (85%) excellent or good, 3 (15%) fair and no poor results. Taking the 17 fingers with zone II lacerations, 14 (82%) were excellent or good, 3 (18%) fair and no poor results.     

Implanted passive engineering mechanism improves hand function after tendon transfer surgery: a cadaver-based study

Purpose

The purpose of this study was to investigate if a new tendon transfer surgical procedure that uses an implanted passive engineering mechanism for attaching multiple tendons to a single donor muscle in place of directly suturing the tendons to the muscle improves hand function in physical interaction tasks such as grasping.

Methods

The tendon transfer surgery for high median ulnar palsy was used as an exemplar, where all four flexor digitorum profundus (FDP) tendons are directly sutured to the extensor carpi radialis longus (ECRL) muscle to restore flexion. The new procedure used a passive hierarchical artificial pulley system to connect the muscle to the tendons. Both the suture-based and pulley-based procedures were conducted on N = 6 cadaver hands. The fingers’ ability to close around four objects when the ECRL tendon was pulled was tested. Post-surgery hand function was evaluated based on the actuation force required to create a grasp and the slip between the fingers and the object after the grasp was created.

Results

When compared with the suture-based procedure, the pulley-based procedure (i) reduced the actuation force required to close all four fingers around the object by 45 % and (ii) improved the fingers’ individual adaptation to the object’s shape during the grasping process and reduced slip by 52 % after object contact (2.99° ± 0.28° versus 6.22° ± 0.66°).

Conclusions

The cadaver study showed that the implanted engineering mechanism for attaching multiple tendons to one muscle significantly improved hand function in grasping tasks when compared with the current procedure.     

Passive ankle motion and calf massage without anticoagulation therapy after total hip arthroplasty: A retrospective study

BackgroundIt has been previously reported that manual calf massage and passive ankle motion after total hip arthroplasty could reduce the incidence of venous thromboembolism. However, a combination of chemical and mechanical prophylaxes was employed. In this study, we aimed to examine the effect of mechanical prevention without pharmacological antithrombotic intervention.MethodsOf the 313 patients who underwent unilateral primary total hip arthroplasty and received passive ankle motion and calf massage postoperatively at our hospital between January 2015 and December 2019, 261 (58 men, 203 women; mean age 62.1 years) were included in this retrospective study. Pharmacological anticoagulation therapy was administered in 176 patients (combination group); 137 patients only underwent calf massage and passive ankle motion without anticoagulation therapy (single group). The study outcomes were operation time, the incidence of deep vein thrombosis, pulmonary thromboembolism, intraoperative bleeding, estimated actual blood loss, blood transfusion, and major bleeding.ResultsNo significant differences were found in sex, age, side, platelet counts, activated partial thromboplastin time, prothrombin time, prothrombin time - International Normalized Ratio, intraoperative blood loss, estimated blood loss, and operation time. Moreover, the incidence of deep vein thrombosis, pulmonary thromboembolism, and intraoperative bleeding was not significantly different between the groups (deep vein thrombosis 4.0% vs. 6.3%, p = 0.244; pulmonary thromboembolism 0.7% vs. 0%, p = 0.548; and intraoperative bleeding 394 ± 173.6 ml vs. 365.4 ± 168.5 ml, p = 0.550). However, estimated actual blood loss and postoperative bleeding differed between the groups (eABL 996.6 ± 348.3 ml vs. 858.5 ± 269.6 ml, p = 0.003; postoperative bleeding 601.8 ± 330.0 ml vs. 492.1 ± 277.1 ml, p = 0.016), and both increased in the combination group. No major bleeding was noted in the two groups.ConclusionPostoperative anticoagulant therapy does not have to be routinely used if mechanical prophylaxis is performed in patients without deep vein thrombosis before total hip arthroplasty.     

Continuous passive motion following partial ankle joint arthroplasty

Retrospective preliminary report of 19 cases undergoing partial ankle joint arthroplasties with open surgical procedures were rehabilitated with continuous passive motion (CPM). Preoperative and post-operative ankle range of motion and subjective findings (pain, physical signs, activity, quality of motion) were evaluated. Results indicated significant increases to ankle joint range of motion with the use of continuous passive motion, decreased pain, increased activity, decreased edema, and improved quality of motion in the majority of patients undergoing ankle joint arthroplasty with continuous passive motion.     

Continuous gentamicin therapy using an IntraEAR microcatheter for Meniere's disease: a retrospective study.

OBJECTIVES: The study goals were to evaluate the safety and effectiveness of continuous gentamicin therapy (CGT) in the treatment of Meniere's disease and to evaluate the effect of flow rate. STUDY DESIGN: In a retrospective study, physicians who were known to have used CGT in the treatment of Meniere's disease were asked to report patient information on a standardized data collection form. RESULTS: In patients treated with low-flow CGT, vertigo was eliminated or substantially controlled in 90%, tinnitus was improved in 69%, pressure was improved in 77%, hearing was worse in 23%, and vestibular function was ablated in only 14% of patients. CONCLUSION: On the basis of an average 10-month follow-up period, of the methods currently available to treat Meniere's patients with gentamicin, low-flow CGT seems to provide an excellent combination of vertigo control and tinnitus and pressure improvement, with a relatively low risk to hearing and vestibular function. SIGNIFICANCE: The clinical use of low-flow CGT appears to be justified based on these data.     

Continuous passive motion versus immobilisation in a cast after surgical treatment of idiopathic club foot in infants: a prospective, blinded, randomised, clinical study

Continuous passive motion has been shown to be effective in the conservative treatment of idiopathic club foot. We wished to determine whether its use after operation could improve the results in resistant club feet which required an extensive soft-tissue release. There were 50 feet in the study. Posteromedial lateral release was performed in 39 feet but two were excluded due to early relapse. The mean age at surgery was eight months (5 to 12). Each foot was assigned a Dimeglio club foot score, which was used as a primary outcome measure, before operation and at 6, 12, 18 and 44 months after. Nineteen feet were randomly selected to receive continuous passive motion and 18 had standard immobilisation in a cast. After surgery and subsequent immobilisation in a cast the Dimeglio club foot score improved from 10.3 before to 4.17 by 12 months and to 3.89 at 48 months. After operation followed by continuous passive motion the score improved from 9.68 before to 3.11 after 12 months, but deteriorated to 4.47 at 48 months. Analysis of variance adjusted for baseline values indicated a significantly better score in those having continuous passive motion up to one year after surgery, but after 18 and 48 months the outcomes were the same in both groups.     

The unoperated hand: the role of passive forces in hand function after tetraplegia

Passive forces play a large role in hand function after tetraplegia. Most individuals with tetraplegia choose not to undergo surgical reconstruction of hand function and, therefore, depend on the passive properties of their musculoskeletal system to perform functional tasks. Knowledge of the levels of force needed to perform many of these tasks is lacking. Understanding the mechanics of producing passive force is important for designing adaptive tools and other devices for tetraplegic individuals. Knowledge of the passive properties of the upper extremity is important in forming treatment strategies. The passive forces produced for change to the tenodesis grasp are small but useful to the individual. Since these forces arise from basic anatomy and muscle function, they are important even after surgical restoration of hand function. Compensatory strategies for the unoperated hand probably play a role in the operated hand. The approach to surgical restoration of grasp must consider how passive forces contribute to functional outcome.     

Low-dose antiplatelet therapy survey after intracerebral hemorrhage in China: a retrospective hospital-based study

Restarting of antiplatelet therapy (AT) for patients with a history of intracerebral hemorrhage (ICH) is still a clinical dilemma in China. We aimed to investigate the association between low-dose AT and the long-term clinical outcome in Chinese ICH patients. A total of 312 patients with a history of ICH were retrospectively enrolled and followed. The ischemic vascular events, recurrent ICH, and all-cause death were reviewed retrospectively. We explored the predictors of ischemic vascular events and recurrent ICH from all patients using Cox proportional hazard regression model. One hundred fifty-one (48.4%) patients were treated with low-dose AT, and the median duration of follow-up was 4.0 years (interquartile range, 2.5–5 years). Compared to 30 (19.8%) of 151 participants who restarted low-dose AT had ischemic vascular events, 51 (31.7%) of 161 participants who did not receive AT showed ischemic vascular events (p=0.025). Eighteen (11.9%) of 151 participants treated with low-dose AT had recurrent ICH and 21 (13.0%) of 161 in non-AT participants (p=0.830). Cox regression analysis also showed that diabetes mellitus was an independent risk factor for ischemic vascular events (p=0.029). Uncontrolled blood pressure (BP) was independently associated with the risk for both ischemic vascular events (p=0.025) and recurrent ICH (p=0.001). Atrial fibrillation (AF) was an independent risk factor for recurrent ICH among patients with a history of ICH (p=0.018). In a Chinese population of patients with predominantly deep, mild to moderate severity ICH, restarting of low-dose AT at a median of 6.2 months was associated with a lower risk of ischemic vascular events without increased risk of recurrent ICH.