Liu Meng-Meng, Tian Mian, Luo Changqi, Wang Shicheng, Shao Long
Department of Pathology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China.
Department of Orthopaedic Surgery, Dianjiang People's Hospital of Chongqing, Chongqing, China.
Front Surg. 2023 Jan 11;9:1073288. doi: 10.3389/fsurg.2022.1073288. eCollection 2022.
Cryotherapy is widely applied to relieve pain and improve functional outcomes after total knee arthroplasty (TKA). New cryotherapy devices have recently been developed to guarantee a fixed temperature for a prolonged time. Therefore, we conducted a systematic review and meta-analysis to compare continuous cryotherapy and traditional cryotherapy (ice bag or gel pack) for patients after TKA.
This study was conducted according to a predefined protocol registered on PROSPERO. Two independent reviewers performed an electronic database search of PubMed, Embase, Cochrane, Web of Science, Google Scholar, and ClinicalTrials.gov. Dichotomous outcomes were reported as risk difference (RD) with 95% confidence intervals (CIs), and continuous outcomes were reported as mean difference (MD), or standardized mean difference (SMD) with 95% CIs.
Seven trials enrolling a total of 519 patients were included. There were no differences in pain intensity (MD: -0.54, 95% CI: -1.55 to 0.47; = 0.30), analgesics consumption (MD: -0.37, 95% CI: -1.28 to 0.55; = 0.43), postoperative range of motion (MD: 0.47, 95% CI: -4.09 to 5.03; = 0.84), swelling of the knee joint, blood loss, change in hemoglobin, or transfusion rate. Meanwhile, there were no differences in length of hospital stay (MD: -0.77, 95% CI: -1.62 to 0.08; = 0.07) and adverse events (RD: 0, 95% CI: -0.02 to 0.03; = 0.74). In addition, continuous cryotherapy leads to extra costs and resources than traditional cryotherapy.
Continuous cryotherapy does not appear to offer significant benefits for TKA when compared with traditional cryotherapy. Based on currently available evidence, traditional cryotherapy is still recommended as continuous cryotherapy is not cost-effective. Further well-designed studies with larger sample sizes are warranted to further confirm these preliminary results. Identifier [CRD42022308217].
冷冻疗法广泛应用于全膝关节置换术（TKA）后缓解疼痛和改善功能结局。最近开发了新的冷冻疗法设备，以确保在较长时间内保持固定温度。因此，我们进行了一项系统评价和荟萃分析，比较TKA术后患者使用持续冷冻疗法和传统冷冻疗法（冰袋或凝胶袋）的效果。
本研究按照在PROSPERO上注册的预定义方案进行。两名独立评审员对PubMed、Embase、Cochrane、Web of Science、Google Scholar和ClinicalTrials.gov进行了电子数据库检索。二分结局报告为风险差（RD）及95%置信区间（CI），连续结局报告为均值差（MD）或标准化均值差（SMD）及95%CI。
纳入了7项试验，共519例患者。在疼痛强度（MD：-0.54，95%CI：-1.55至0.47；P = 0.30）、镇痛药消耗量（MD：-0.37，95%CI：-1.28至0.55；P = 0.43）、术后活动范围（MD：0.47，95%CI：-4.09至5.03；P = 0.84）、膝关节肿胀、失血量、血红蛋白变化或输血率方面无差异。同时，在住院时间（MD：-0.77，95%CI：-1.62至0.08；P = 0.07）和不良事件（RD：0，95%CI：-0.02至0.03；P = 0.74）方面也无差异。此外，与传统冷冻疗法相比，持续冷冻疗法会导致额外的成本和资源消耗。
与传统冷冻疗法相比，持续冷冻疗法对TKA似乎没有显著益处。基于现有证据，仍推荐传统冷冻疗法，因为持续冷冻疗法不具有成本效益。需要进一步开展设计良好、样本量更大的研究来进一步证实这些初步结果。标识符[CRD42022308217]
