Pieri Leonardo, Leggieri Filippo, Bartoli Dimitri, Ponti Marco, Caparrini Chiara, Baldini Andrea
Istituto Fiorentino Di Cura E Assistenza (IFCA), Florence, Italy.
Department of Clinical Orthopedics, University of Florence, Florence, Italy.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 2. doi: 10.1002/ksa.12756.
Cryotherapy modulates synovial fluid composition by reducing inflammatory mediators and altering metabolite concentrations, resulting in both anti-inflammatory and anti-oxidative effects. The aim was to investigate whether preoperative cryocompression would (1) maintain deep tissue hypothermia during the surgical procedure, (2) attenuate inflammatory response and tissue damage, and (3) improve post-operative outcomes.
The study enroled patients undergoing total knee arthroplasty (TKA) surgery who were randomly assigned to either the control group (n = 50) receiving post-operative cryocompression therapy, or the intervention group (n = 50) receiving both preoperative and post-operative cryocompression.
coagulation/psychiatric disorders.
monolateral primary Kellgren-Lawrence Grade IV knee osteoarthritis. Multiple outcomes, including patient-reported outcomes (PROs), discharge milestones, cutaneous/osseous temperature and inflammatory biomarkers, were assessed. The primary end point was the difference in inflammatory markers across cohorts, while secondary end points included differences in pain, patient-reported outcome measures (PROMs) and range of motion (ROM). Chi-square test was used for categorical variables and the Mann-Whitney U test for continuous variables. The minimally clinically important difference was calculated using the 0.5 SD approach. Linear mixed-effects models analyzed the differences in inflammatory markers between the cohorts over time. The alpha value was set at 0.05.
Differences between the contralateral and the operated knee skin temperatures (Z = -4.5, p < 0.001), as well as between the contralateral knee skin temperature and the operated knee bone temperature (Z = -4.9, p < 0.001) were found. (2) Erythrocyte sedimentation rate was lower in the intervention group on post-operative Days 1 and 2 compared to the control group. Fibrinogen had a greater increase from preoperative to post-operative in the control group (U = 746.5, p = 0.018). (3) Higher ROM (p = 0.001) and shorter time to reach the rehabilitation milestones to discharge (p = 0.007) were found in the intervention group.
Preoperative cryocompression therapy before TKA might reduce early post-operative inflammation, accelerate rehabilitation milestones, and improve early ROM.
Level IV.
冷冻疗法通过减少炎症介质和改变代谢物浓度来调节滑液成分，从而产生抗炎和抗氧化作用。本研究旨在探讨术前冷冻加压是否会（1）在手术过程中维持深部组织低温，（2）减轻炎症反应和组织损伤，以及（3）改善术后结局。
本研究纳入接受全膝关节置换术（TKA）的患者，这些患者被随机分为对照组（n = 50），接受术后冷冻加压治疗，或干预组（n = 50），接受术前和术后冷冻加压治疗。
凝血/精神疾病。
单侧原发性凯尔格伦-劳伦斯IV级膝关节骨关节炎。评估了多个结局，包括患者报告的结局（PROs）、出院里程碑、皮肤/骨温度和炎症生物标志物。主要终点是各队列间炎症标志物的差异，次要终点包括疼痛、患者报告的结局指标（PROMs）和活动范围（ROM）的差异。分类变量采用卡方检验，连续变量采用曼-惠特尼U检验。使用0.5 SD方法计算最小临床重要差异。线性混合效应模型分析了各队列随时间变化的炎症标志物差异。α值设定为0.05。
发现对侧膝关节与手术侧膝关节皮肤温度之间存在差异（Z = -4.5，p < 0.001），以及对侧膝关节皮肤温度与手术侧膝关节骨温度之间存在差异（Z = -4.9，p < 0.001）。（2）与对照组相比，干预组术后第1天和第2天的红细胞沉降率较低。对照组术前至术后纤维蛋白原的增加幅度更大（U = 746.5，p = 0.018）。（3）干预组的ROM更高（p = 0.001），达到出院康复里程碑的时间更短（p = 0.007）。
TKA术前冷冻加压治疗可能会减轻术后早期炎症，加速康复里程碑，并改善早期ROM。
IV级。
