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Comparative Effectiveness Review of Cold Compression Therapy for Patients Undergoing Total Knee Arthroplasty

March 28, 2019

Health Problem: Acute postoperative pain and swelling is common following total knee arthroplasty (TKA). Inadequately controlled pain negatively affects quality of life and recovery of function and may result in an increase in morbidity, recovery time, opioid use, and risk of complications or persistent postsurgical pain. According to 2010 data, approximately 4.7 million people (1.52% of the population) in the United States have undergone TKA at some point in their lifetime.

Technology Description: Cold compression (CC) therapy involves the simultaneous application of cold and compression through a device that generally consists of a cuff or wrap and a cooler with or without a pump. The intended benefits of CC therapy are reduced pain and inflammation and improved recovery in the postoperative setting.

Controversy: Currently, there does not appear to be a well-established protocol for the administration of CC therapy, which can be either intermittent or continuous for up to several days. Nursing activities related to CC therapy include equipment setup, maintenance of ice supply to the machine, and removal and cleaning of the machine. This has been estimated to contribute 1 to 2 hours of work in addition to routine observations and care over a 24-hour period.

Key Questions:

  • Does CC therapy offer additional benefit for reducing pain and swelling and improving function compared with alternative therapies in patients undergoing TKA?
  • How does CC therapy compare with alternative therapies with respect to safety in patients undergoing TKA?
  • Have definitive patient selection criteria been identified for CC therapy in patients undergoing TKA?