Postoperative Cryotherapy in Joints Other Than the Knee: A Systematic Review of Pain, Edema, Analgesic Use, and Blood Loss in the Shoulder, Hand, Hip, and Ankle Joints.

Abstract

Background: Cryotherapy has proven effective for pain reduction in the knee joint. However, its efficacy in other joints is less clear.

Purpose: To explore the benefits of cryotherapy in joints excluding the knee.

Study design: Systematic review; Level of evidence, 4.

Methods: In June 2023, a review of EMBASE, PubMed MEDLINE, PROSPERO, ClinicalTrials.org, and the Cochrane Library was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Search terms were "cryotherapy,""cold application,""postoperative," and "postoperative period." Studies that assessed postoperative cryotherapy in joints excluding the knee were included. Spine, tumor, and pediatric studies were excluded. Outcomes evaluated were postoperative pain status, analgesic use, edema, and blood loss.

Results: Out of 6749 studies, 22 studies (1424 patients) were ultimately included. Postoperative pain was evaluated in 20 studies, analgesic consumption in 14 studies, edema in 8 studies, and blood loss in 6 studies. Cryotherapy showed significant benefits in pain reduction in 9 studies, decreased analgesic use in 7 studies, edema reduction in 4 studies, and decreased blood loss in 2 studies. The hip showed the most consistent benefits from cryotherapy, across all studied parameters. However, increased haloperidol consumption was noted in hip fractures. Cryotherapy benefits after wrist surgery (4 studies; 211 patients) varied by procedure. Particularly for carpal tunnel procedures, continuous cryotherapy showed significant reductions in pain, analgesic use, and postoperative edema. For ankle surgeries (4 studies; 301 patients), cryotherapy was beneficial for pain and analgesic consumption, but it was not the optimal edema-resolving method. Benefits in elbow surgery (1 study; 59 patients) were limited to pain and analgesia consumption. For shoulder surgery (6 studies; 311 patients), the evidence was not consistent regarding the benefits of cryotherapy on postoperative pain despite a general trend toward amelioration, with compression cryotherapy and continuous cryotherapy showing the best results.

Conclusion: The effectiveness of cryotherapy appeared dependent on the specific surgical context and the protocol used. Pairing cryotherapy with compression led to better outcomes than cryotherapy alone. Special consideration should be given when implementing cryotherapy after hip fractures.