OBJECTIVE: To examine efficacy, effectiveness and most effective dose parameters of CPM after TKA. DESIGN: Systematic review. SETTING: Gelre Hospitals Apeldoorn and Dutch Institute of Allied Health Care, The Netherlands. MATERIALS AND METHODS: Using a structured search strategy we searched several databases up to February 2006. The included studies were analyzed for methodological quality using the "Maastricht-Amsterdam Consensus list". RESULTS: Literature search revealed 53 publications, of which 8 were excluded. The 45 remaining studies showed a mean methodological quality score of 40.6 +/- 12.9 points. Ten studies (22%) scored over 50 points (mean 59.2 +/- 6.3). Three studies showed positive effects of CPM for short term ROM and two studies for incidence of needed manipulations and pain intensity. Positive effects for knee circumference, 'functional status' and muscle strength were found by one study each. One pragmatic study showed a relatively progressive CPM treatment to be more effective than a relatively conservative form. CONCLUSIONS: There is moderate evidence for CPM after TKA being effective for (short term) ROM. There is limited evidence for CPM being effective for incidence of manipulations, pain intensity, knee circumference, 'functional status' and muscle strength. Evidence is limited for a relatively progressive form of CPM being the most effective.

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