This summary of a Cochrane review presents what we know from research about the effects of cold therapy as a therapeutic intervention right after total knee replacement surgery for patients with osteoarthritis.

The review shows that in people who have had a total knee replacement:

– Cryotherapy may slightly reduce the amount of blood loss and pain
– Cryotherapy was generally safe and not associated with any serious adverse events
– Cryotherapy may improve the range of movement at the knee in the first one to two weeks after surgery
– No studies were found that looked at the effects of cryotherapy on a person’s activities related to knee function (or quality of life, or general activity level)

What is total knee replacement and what is cold therapy?

Osteoarthritis is a disease of the joints, such as your knee. Osteoarthritis of the knee can make the knee joint painful and restrict function. Knee replacement surgery is a treatment that can help in this condition in the long term, but the effects of surgery during the recovery period (i.e. up to the first six months) are debilitating. Cold therapy (or cryotherapy) involves the application of very low temperatures to the skin surrounding an injury or surgical site. This can be by means of bags of ice or specialised devices that deliver cooled water to the area.

This review shows that there is evidence that cryotherapy may reduce pain and increase the range of movement in the first few days after a total knee replacement, but the use of cryotherapy does not reduce the need for blood transfusion. Use of cryotherapy is safe and did not result in an increase in serious complications.

Best estimate of what happens to people who have a total knee replacement and receive cryotherapy:

Blood loss
– People who received cryotherapy had on average 225ml less blood loss than people who did not have cryotherapy

Pain
– People who received cryotherapy reported less pain day 2 postoperatively, on average 1.3 points less on a scale of 0 to 10, but pain levels at day 1 and day 3 showed no difference.

Adverse events (unwanted effect including discomfort, local skin reactions, skin infections, cold-related injuries and blood clots)

– 34 out of 1000 people who received cryotherapy experienced one or more unwanted effects
– 34 out of 1000 people who did not receive cryotherapy also experienced one or more unwanted effects

Range of motion

– People who received cryotherapy were able to bend their knee 11 degrees more at the time of discharge from hospital

Transfusion rate (the requirement for a blood transfusion after the surgery)

– This was not reduced in patients who had cryotherapy

Function

– There was no evidence found about the effects of cryotherapy on knee function