GUIDELINES FOR THE USE OF CONTINUOUS PASSIVE MOTION

ONE WEEK POST-OPERATION

• The patient will be instructed on the use of the CPM while in the hospital (ex, continuous use of the CPM at the slowest speed (ex, 1-2 cycles/min) or as tolerated).  The patient should wear the knee immobilizer when not using the CPM.
• Initial CPM ROM s set at 0 degrees extension to 60 degrees – 70 degrees flexion.  The ROM is gradually increased a few degrees in the AM and PM each day if this does not cause considerable pain.  

HOME CPM PROGRAM (4-7 DAYS POST OPERATION)

• The patient will continue to use the CPM at the slowest speed (ex, 1-2 cycles/min).  Continue to gradually increase the CPM ROM. 
• The CPM is used for 8-10 hours during the day (ex, 4-5 hours in the AM and 4-5 hours in the PM).
• The patient should have about 90-100 degrees of flexion 7 days post-operation.
• Perform passive knee extension ROM exercises when not using the CPM.  (ex, elevate the foot for 5-10 minutes allowing the knee to passively extend).

TWO WEEKS POST-OPERATION

• The patient should continue to use the CPM at the slowest speed or tolerance.
• The CPM is used for 6-hours per day (ex, 3-4 hours in the AM and 3-4 hours in the PM).
• The patient should gradually increase the ROM a few degrees in the AM and in the PM each day according to the patient’s pain tolerance.
• The patient should begin wall slides (as instructed by the physical therapist) at home to facilitate progression towards increased flexion.
• The patient should have reached 100 degrees to 110 degrees flexion by the end of the second week.
• The patient should continue passive knee extension exercises to maintain 0 degrees extension when not using the CPM.

THREE WEEKS POST-OPERATION

• The patient will continue to use the CPM at the slowest speed or tolerance.
• The CPM is used for 3-5 hours per day (ex, 1.5-2.5 hours in the AM and 1.5-2.5 hours in the PM).
• At this time, the CPM is used in conjunction with physical therapy and helps to maintain the ROM gained in therapy.  If the patient progresses quickly in physical therapy, then the CPM range of motion setting is adjusted accordingly.
• The patient should have reached 115-120 degrees of flexion by the end of the third week.

FOUR WEEKS POST-OPERATION

• The patient should continue to use the CPM for 2-3 hours per day until the end of the fourth week.  If there are no signs of tightness, stiffness, or adhesions forming, and the maximum flexion range of the machine is reached, then the use of the CPM may be discontinued.
• The patient is to continue wearing the knee brace when not using the CPM or performing exercises at home or during physical therapy.