The use of continuous passive motion after total knee arthroplasty remains controversial. A new approach, starting continuous passive motion at 70 degrees to 100 degrees flexion in the recovery room (group I) was evaluated. A randomized, prospective study of 210 consecutive total knee arthroplasties was performed at two institutions. The control population (group II) started continuous passive motion at 0 degree to 30 degrees, and progressed toward 100 degrees flexion. Flexion at postoperative day 3 (group I = 82.5 degrees, group II = 72.8 degrees), and at discharge (group I = 89.1 degrees, group II = 84.3 degrees) were significantly different. There was no significant difference between the groups at 4 weeks (group I = 5.0 degrees to 104.1 degrees, group II = 5.6 degrees to 102.0 degrees), 6 weeks (group I = 2.3 degrees to 104.8 degrees, group II = 2.7 degrees to 103.6 degrees), 12 weeks (group I = 1.7 degrees to 107.7 degrees, group II = 4.7 degrees to 108.2 degrees), or at 1 year (group I = 0.5 degree to 113.2 degrees, group II = 1.8 degrees to 110.5 degrees). In group I, wound necrosis developed in one patient that required a gastrocnemius flap. This major complication was caused by a tight dressing, and not necessarily to the accelerated flexion continuous passive motion. This investigation shows that continuous passive motion using accelerated flexion allows increased flexion during the hospital stay without increased risk of complications, pain, or blood loss. This has significant implications for achieving safe, early discharge. However, no difference was found at followup of 4 weeks or greater, and this did not add significantly to the final outcome.
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