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Aggarwal 2023 | TKA
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Aggarwal A, Adie S, Harris IA, Naylor J. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2023 Sep 14;9(9):CD007911.
30 However, the certainty of evidence was low due to bias, indirectness, imprecision and inconsistency. More well-designed RCTs are needed. Design: Systematic Review ( Cochrane ) Methods: randomised controlled trials or controlled clinical trials comparing cryotherapy with or without other treatments (such as compression, regional nerve block or continuous passive motion) to no treatment, or the other treatment alone, following TKR for osteoarthritis were included. Outcomes included: blood loss, pain, knee ROM, knee function, adverse events, analgesia use, swelling, length of stay, quality of life, activity level. Results: • Different comparisons of cryotherapy and controls (with/without compression) were performed by subgrouping studies in each analysis. • Subgroup analysis noted a trend in favour of interventions combining cold and compression for blood loss, pain, analgesia uses and swelling. • For combined blood loss, the mean difference (MD) was 0.84 mL less blood loss (95% CI 1.61 less to 0.06 more; P = 0.03) in the combined cold and compression group. • For pain at post-operative day two, the MD was 1.88 points less (95% CI 2.52 less to 1.24 less; P < 0.001) in the combined cold and compression group • For combined analgesic use, the SMD was 0.30 units lower (95% CI 0.59 lower to 0.00; P = 0.05) within the cold and compression group • For change in knee swelling at mid-patella between postop days 2-6, the MD was 7.63 mm less (95% CI 12.52 to 2.75 mm less; P = 0.002) in the combined group. •
Key message: Subgroup analysis noted a trend in favour of interventions combining cold and compression for blood loss, postoperative pain (day 2), analgesia use and swelling at mid patella (days 2-6).
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