Over the past decade continuous passive motion (CPM) has found increasing popularity in the management of patients undergoing total knee arthroplasty (TKA). However, the literature contains many controversies about the advantages of CPM and although it has been shown to have some value, there has been no conclusive work on its most beneficial mode of use. The objective of this study was to determine whether patients undergoing TKA benefit from having CPM incorporated into their conventional physiotherapy regime (in terms of speed and quality of recovery) and to establish whether further resource allocation was justified. Pre-operatively 113 TKA patients were randomly allocated to one of two groups, in a prospective study. Both groups performed a standardised exercise programme and one group also spent six hours each day on a CPM machine. The results showed that CPM significantly improved knee range -- of movement following surgery and patients found it easier to regain their movement. Patients who had CPM recorded lower pain levels and spent less time in hospital, with fewer requiring out-patient physiotherapy. However, these latter results did not reach statistical significance. CPM did not increase the patient's analgesic requirements or wound drainage and neither did it increase the indicence of complications. The groups of patients who appeared to gain the most benefit are identified and an optimum CPM regime is recommended. CPM has a value in the treatment of patients following TKA and apart from the initial cost of the machines, there is little increase in resource requirements when CPM is used as an adjunct to treatment.

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