Original Research

Continuous Cryotherapy vs Ice Following Total Shoulder Arthroplasty: A Randomized Control Trial

Publish date: June 19, 2018

References

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The mechanism of cryotherapy for controlling pain is poorly understood. Cryotherapy reduces leukocyte migration and slows down nerve signal transmission, which reduces inflammation, thereby producing a short-term analgesic effect. Stalman and colleagues² reported on a randomized control study that evaluated the effects of postoperative cooling after knee arthroscopy. Measurements of metabolic and inflammatory markers in the synovial membrane were used to assess whether cryotherapy provides a temperature-sensitive release of prostaglandin E_2. Cryotherapy lowered the temperature in the postoperative knee, and synovial prostaglandin concentrations were correlated with temperature. Because prostaglandin is a marker of inflammation and pain, the conclusion was that postoperative cooling appeared to have an anti-inflammatory effect.

The knee literature contains multiple studies that have examined the benefits of cryotherapy after both arthroscopic and arthroplasty procedures. The clinical benefits on pain have been equivocal with some studies showing improvements using cryotherapy^3,4and others showing no difference in the treatment group.^5,6

Few studies have examined cryotherapy for the shoulder. Speer and colleagues⁷ demonstrated that postoperative use of CC was effective in reducing recovery time after shoulder surgery. However; they did not provide an ICE comparative group and did not focus specifically on TSA. In another study, Kraeutler and colleagues⁸ examined only arthroscopic shoulder surgery cases in a randomized prospective trial and found no significant different between CC and ICE. They concluded that there did not appear to be a significant benefit in using CC over ICE for arthroscopic shoulder procedures.

The purpose of this study is to prospectively evaluate CC and ICE following TSA. The hypothesis was that CC leads to improved pain control, less narcotic consumption, and improved quality of sleep compared to ICE in the immediate postoperative period following TSA.

MATERIALS AND METHODS

This was a prospective randomized control study of patients undergoing TSA receiving either CC or ICE postoperatively. Institutional Review Board approval was obtained before commencement of the study. Inclusion criteria included patients aged 30 to 90 years old undergoing a primary or revision shoulder arthroplasty procedure between June 2015 and January 2016. Exclusion criteria included hemiarthroplasty procedures.

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