Fast Track Recovery Knee Arthroplasty Project (FARP)

• Range of motion [ Time Frame: preoperative, 2,4 and 6 days postoperative ] [ Designated as safety issue: No ]

  Change in Range of motion

  Range of motion is measured with a goniometer using the Neutral position method and compared to previous measured values.

• Pain [ Time Frame: preoperative, 2,4 and 6 days postoperative ] [ Designated as safety issue: No ]

  Change in pain

  pain is evaluated using the Visual Analogue Scale (VAS). The evaluated pain scores are compared to previous pain scores

Fast Track Recovery Arthroplasty Project is supposed to analyse a new medical method to accelerate patient's remobilisation process after total knee endoprostheses. The method, called c-treatment, is a computer-controlled cryotherapy (soothing cooling therapy) at which the device measures temperature at the affected site (the operated knee in the investigators investigation) and optimizes the cooling temperature. The optimized cooling therapy is supposed to reduce swelling and postoperative pain whereby patient's postoperative mobilization can be done earlier leading to a reduction of length of hospitalization.

To verify c-treatment's efficiency compared to conventional cryotherapy, patients are split in a test group and a standard group. The standard group is treated following the standard protocol at the Department of Orthopaedics Surgery Graz using cold packs (Fa. Dahlhausen, product code 93.000.00.042). Patient's in the test group receive c-treatment therapy following the study protocol.

All patients are instructed to fill in standardized questionnaires to evaluate social scores and pain scores preoperative as well as postoperative. The knee's swelling and range of motion as well as blood parameters monitoring the healing process are measured following the study protocol.

The comparison of these parameters between the standard and the test group is supposed to verify c-treatment's efficiency.

Patients receiving a total knee endoprosthesis at the Department of Orthopaedics Surgery Graz

• c-treatment
  test group
• standard cooling
  comparison group

• Herbold JA, Bonistall K, Walsh MB. Rehabilitation following total knee replacement, total hip replacement, and hip fracture: a case-controlled comparison. J Geriatr Phys Ther. 2011 Oct-Dec;34(4):155-60.
• Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010 Sep;40(9):559-67.
• Sultan PG, Most E, Schule S, Li G, Rubash HE. Optimizing flexion after total knee arthroplasty: advances in prosthetic design. Clin Orthop Relat Res. 2003 Nov;(416):167-73. Review.
• Markert SE. The use of cryotherapy after a total knee replacement: a literature review. Orthop Nurs. 2011 Jan-Feb;30(1):29-36. Review.
• Adie S, Naylor JM, Harris IA. Cryotherapy after total knee arthroplasty a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2010 Aug;25(5):709-15. Epub 2009 Sep 2. Review.
• Holmström A, Härdin BC. Cryo/Cuff compared to epidural anesthesia after knee unicompartmental arthroplasty: a prospective, randomized and controlled study of 60 patients with a 6-week follow-up. J Arthroplasty. 2005 Apr;20(3):316-21.

Inclusion Criteria:

• degenerative or posttraumatic gonarthrosis or osteonecrosis around the knee
• scheduled operation for total knee endoprosthesis
• age between 18 and 90 years
• patient agrees with study design, therapy and postoperative controls
• education form is signed by patient and physician

Exclusion Criteria:

• Body Mass Index greater than 40
• varus or valgus deformity greater than 10 degrees
• impaired extension greater than 10 degrees
• flexion preoperative less than 90 degrees
• cold urticaria
• cryoglobulinemia
• paroxysmal cold hemoglobinuria
• current fracture around the knee
• current infection or status post infection
• rheumatoid arthritis at knee
• tumor around the knee
• any operations done around the knee except arthroscopic knee surgery
• active systemic infection (HIV, HBV, HCV)
• obstructive sleep apnea
• opioid intolerance
• incompliance concerning patient controlled analgesia
• cold allergy or cold intolerance
• Raynaud's Disease
• circulatory disorder at the affected leg
• fibromyalgia or other chronic pain syndromes
• taking of immune modulating medication as cortisone, interferon or similar
• depression or anxiety disorder
• addicted to drugs or alcohol
• pregnancy or possible pregnancy without adequate contraception
• no signed education form
• unsoundness of mind