Continuous Passive Motion

1
Continuous Passive Motion

• Continuous Passive Motion (CPM) refers to
  passive motion that is performed by a mechanical
  device that moves a joint slowly and continuously
  through a controlled range of motion.

2
Continuous Passive Motion Device for the Knee.
3
Benefits of Continuous Passive Motion

• Preventing development of adhesion, contracture
  and joint stiffness.
• Providing a stimulating effect on the healing of
  tendons and ligaments.
• Minimizing the effect of immobilization.
• Increasing the synovial fluid of the joint so
  increase rate of intra-articular healing.

4

• Indications
• After joint surgery, including anterior cruciate
  ligament (ACL)
• After knee arthoroplasty
• After surgical repair of stable intra-articular
  or extra-articular fractures
• After meniscectomy
• After osteochondral repair

5

• Contraindication
• Continuous passive motion is contraindicated in
  cases for which the device can cause unwanted
  translation of opposing bones, overstressing the
  healing process.

6

• Precautions
• The use of CPM in conjunction with
  anticoagulation therapy may produce an
  intra-compartmental haematoma.
• Skin irritation from the straps or carriage cover
  may develop.

7
Clinical Application of Continuous Passive
Motion

• General Principles
• The CPM unit is often applied in the recovery
  room immediately after surgery even when the
  patient is wearing brace or surgical bandages.
• The arc of motion for the joint is determined.
  Often a low arc of 20 to 30 degrees is used
  initially and progressed to 10 to 15 degrees per
  day.
• The rate of motion is usually 1 cycle per 45
  seconds or per 2 minutes.
• The amount of time on the CPM machine ranges from
  1 hour, three time a day to continuous for 24
  hours. After surgery use is for 6 to 8 hours a
  day.
• Physical therapy treatment is provided during the
  time the patient is not on the CPM machine.
• Duration minimum for CPM is usually less than one
  week when a satisfactory range of motion is
  reached.

8
The following protocol is provided as an example
for a post-ACL reconstructive surgery.

• Setup and Application
• Measure the length of the patients thigh from
  the ischial tuberosity to the joint line of the
  knee. Adjust the proximal carriage so that the
  proximal end meets the bottom of the buttocks.
• Determine the length of the lower leg by
  measuring from the joint line of the knee to
  approximately ¼ inch beyond the heel. Adjust the
  distal portion of the carriage accordingly.
• Place the lower extremity in the unit with the
  joint line of the knee aligned to the articular
  hinge of the CPM unit.
• Adjust the foot in the footplate so that the
  tibia is placed in the neutral position. Internal
  or external rotation of the tibia can result in
  increased stress on the ACL.

9

• Set the Rom as prescribed by the surgeon. Usually
  started with a limited ROM (0 to 60 degrees) and
  progress to the full ROM as healing occurs.
• Set the speed of the treatment (e.g., cycle time
  of 4 minutes 15 cycles per hour).
• Give the patient the hand held control and
  provide instruction on how and when to use it,
  including increasing speed and ROM and
  termination of the treatment.
• After termination of the treatment remove the
  machine and clean the mechanical housings with
  soap specially if the unit become soiled with
  blood or synovial fluid.
• Dispose of the carriage cover or wash it
  according to the manufactures instructions.