Combined Cryotherapy With Compression Versus Cryotherapy Alone After Orthopaedic Surgery

NCT ID: NCT05011084

Last Updated: 2025-10-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

348 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-02

Study Completion Date

2026-07-28

Brief Summary

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Cryotherapy has been used to enhance recovery after orthopaedic surgery. Many devices are available but few can guarantee a temperature regulation during a prolonged time and therefore have been criticized. The arrival of new advanced cryotherapy devices made it possible to test the effect of prolonged cooling on rehabilitation after arthroscopic orthopaedic procedures.

Detailed Description

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Opioids are most commonly administered for the treatment of pain and are among the most prescribed drugs in the United States (US). Between 2003 and 2011, opioid prescriptions increased from 149 million to 238 million \[3,5,7,11\]. In 2004, while constituting only 4.5% of the world's population, the US consumed 99% of the global supply of hydrocodone \[3,11\]. These trends resulted in the Centers for Disease Control and Prevention recognizing opioid abuse as an epidemic \[2,11\].

Pain management after orthopaedic arthroscopic procedures is mandatory regardless of the surgical technique. Cold therapy (cryotherapy) has been widely used for many years in the treatment of postoperative pain management in orthopaedic surgery and most studies have reported better pain scores and reduced drug consumptions \[1,6,8\]. Cryotherapy involves applying a cold device to the skin surrounding the injured soft tissues to reduce the intraarticular temperature. It reduces local blood flow by vasoconstriction, which in turn also reduces local inflammatory reaction, swelling, and heat experience. It also decreases the conduction of nerve signals potentially reducing pain transmission \[14,15\]. Several cryotherapy options are available: first generation cold therapy like crushed ice in a plastic bag, cold or gel packs; second-generation cold therapy with circulating ice water with or without compression; and third-generation advanced computer-assisted devices with continuous controlled cold therapy.

Cryotherapy is the standard of care in some countries and rarely is used in others \[17\]. Conflicting evidence regarding the value of this treatment from randomized trials may contribute to that practice disparity \[16\]. Raynor et al \[8\] showed that cryotherapy has a statistically significant benefit in postoperative pain control, while no improvement in postoperative range of motion or drainage was found. Cryotherapy with compression units are inexpensive, easy to use, have a high level of patient satisfaction, and are rarely associated with adverse events. Raynor et al \[8\] concluded cryotherapy may be justified in the postoperative management of knee surgery.

Postoperative cryotherapy with compression was proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopaedic arthroscopic procedures. Previous study results are equivocal. Kraeutler et al \[12\] reported that there does not appear to be a significant benefit to use of cold compression over standard ice wraps in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. While Alfuth et al \[13\] concluded no recommendations can be made regarding the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Our goal is to analyze the analgesic efficacy of cryotherapy after shoulder, knee, and hip arthroscopic procedures using the Game Ready © which is a second generation cryotherapy with compression system. The investigators hypothesize this may decrease postoperative opioid usage as well as be more cost effective when compared to first generation cryotherapy (ice packs without compression) for medical healthcare systems.

Conditions

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Cryotherapy Effect Compression Postoperative Pain Management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Game Ready Cryotherapy with Compression Group

Post-operative treatment will involve using a Game Ready ® unit

Group Type EXPERIMENTAL

Game Ready Cryotherapy with Compression Group

Intervention Type DEVICE

Instead of using the traditional ice-pack cryotherapy (without compression), patients randomized into this group will use the Game Ready device, which uses cryotherapy with compression, during their post-operative treatment care.

Control Cryotherapy Group

Post-operative treatment will involve using the standard of care cryotherapy (i.e., traditional ice packs without compression).

Group Type ACTIVE_COMPARATOR

Control Cryotherapy Group

Intervention Type OTHER

Patients randomized to the control group will use the standard of care, which is using traditional cryotherapy (i.e., an ice pack without compression)

Interventions

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Game Ready Cryotherapy with Compression Group

Instead of using the traditional ice-pack cryotherapy (without compression), patients randomized into this group will use the Game Ready device, which uses cryotherapy with compression, during their post-operative treatment care.

Intervention Type DEVICE

Control Cryotherapy Group

Patients randomized to the control group will use the standard of care, which is using traditional cryotherapy (i.e., an ice pack without compression)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult (18 years of age or older)
* Eligible for DEERS (Defense Enrollment Eligibility Reporting System - A system that enables uniformed service members \& family members to receive health care through TRICARE)
* Fluent in speaking, reading, and understanding English
* Scheduled to receive one of the following procedures: Knee arthroscopy, Shoulder arthroscopy, or Hip arthroscopy

Exclusion Criteria

* Unable to understand and/or provide written informed consent
* Presence of concurrent additional injuries (e.g., both a knee and hip injury). Participants can only have one injury
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Walter Reed National Military Medical Center

FED

Sponsor Role lead

Responsible Party

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Ashley Bozzay, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ashley B Bozzay, MD

Role: PRINCIPAL_INVESTIGATOR

Walter Reed National Military Medical Center

Locations

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Walter Reed National Military Medical Center

Bethesda, Maryland, United States

Site Status

Countries

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United States

References

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Barber FA, McGuire DA, Click S. Continuous-flow cold therapy for outpatient anterior cruciate ligament reconstruction. Arthroscopy. 1998 Mar;14(2):130-5. doi: 10.1016/s0749-8063(98)70030-1.

Reference Type BACKGROUND
PMID: 9531122 (View on PubMed)

Chakravarthy B, Shah S, Lotfipour S. Prescription drug monitoring programs and other interventions to combat prescription opioid abuse. West J Emerg Med. 2012 Nov;13(5):422-5. doi: 10.5811/westjem.2012.7.12936.

Reference Type BACKGROUND
PMID: 23357954 (View on PubMed)

Kuehn BM. Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA. 2007 Jan 17;297(3):249-51. doi: 10.1001/jama.297.3.249. No abstract available.

Reference Type BACKGROUND
PMID: 17227967 (View on PubMed)

Kumar K, Gulotta LV, Dines JS, Allen AA, Cheng J, Fields KG, YaDeau JT, Wu CL. Unused Opioid Pills After Outpatient Shoulder Surgeries Given Current Perioperative Prescribing Habits. Am J Sports Med. 2017 Mar;45(3):636-641. doi: 10.1177/0363546517693665. Epub 2017 Feb 9.

Reference Type BACKGROUND
PMID: 28182507 (View on PubMed)

Manchikanti L, Helm S 2nd, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Opioid epidemic in the United States. Pain Physician. 2012 Jul;15(3 Suppl):ES9-38.

Reference Type BACKGROUND
PMID: 22786464 (View on PubMed)

Morsi E. Continuous-flow cold therapy after total knee arthroplasty. J Arthroplasty. 2002 Sep;17(6):718-22. doi: 10.1054/arth.2002.33562.

Reference Type BACKGROUND
PMID: 12216025 (View on PubMed)

Nelson AD, Camilleri M. Chronic opioid induced constipation in patients with nonmalignant pain: challenges and opportunities. Therap Adv Gastroenterol. 2015 Jul;8(4):206-20. doi: 10.1177/1756283X15578608.

Reference Type BACKGROUND
PMID: 26136838 (View on PubMed)

Raynor MC, Pietrobon R, Guller U, Higgins LD. Cryotherapy after ACL reconstruction: a meta-analysis. J Knee Surg. 2005 Apr;18(2):123-9. doi: 10.1055/s-0030-1248169.

Reference Type BACKGROUND
PMID: 15915833 (View on PubMed)

Schoenfeld AJ, Belmont PJ Jr, Blucher JA, Jiang W, Chaudhary MA, Koehlmoos T, Kang JD, Haider AH. Sustained Preoperative Opioid Use Is a Predictor of Continued Use Following Spine Surgery. J Bone Joint Surg Am. 2018 Jun 6;100(11):914-921. doi: 10.2106/JBJS.17.00862.

Reference Type BACKGROUND
PMID: 29870441 (View on PubMed)

Scully RE, Schoenfeld AJ, Jiang W, Lipsitz S, Chaudhary MA, Learn PA, Koehlmoos T, Haider AH, Nguyen LL. Defining Optimal Length of Opioid Pain Medication Prescription After Common Surgical Procedures. JAMA Surg. 2018 Jan 1;153(1):37-43. doi: 10.1001/jamasurg.2017.3132.

Reference Type BACKGROUND
PMID: 28973092 (View on PubMed)

Syed UAM, Aleem AW, Wowkanech C, Weekes D, Freedman M, Tjoumakaris F, Abboud JA, Austin LS. Neer Award 2018: the effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial. J Shoulder Elbow Surg. 2018 Jun;27(6):962-967. doi: 10.1016/j.jse.2018.02.039. Epub 2018 Mar 26.

Reference Type BACKGROUND
PMID: 29599038 (View on PubMed)

Kraeutler MJ, Reynolds KA, Long C, McCarty EC. Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression. J Shoulder Elbow Surg. 2015 Jun;24(6):854-9. doi: 10.1016/j.jse.2015.02.004. Epub 2015 Mar 29.

Reference Type BACKGROUND
PMID: 25825138 (View on PubMed)

Alfuth M, Strietzel M, Vogler T, Rosenbaum D, Liem D. Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2209-15. doi: 10.1007/s00167-015-3534-7. Epub 2015 Feb 13.

Reference Type BACKGROUND
PMID: 25677503 (View on PubMed)

Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med. 2007 Jun;41(6):365-9; discussion 369. doi: 10.1136/bjsm.2006.031237. Epub 2007 Jan 15.

Reference Type BACKGROUND
PMID: 17224445 (View on PubMed)

Kullenberg B, Ylipaa S, Soderlund K, Resch S. Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. J Arthroplasty. 2006 Dec;21(8):1175-9. doi: 10.1016/j.arth.2006.02.159.

Reference Type BACKGROUND
PMID: 17162178 (View on PubMed)

Adie S, Naylor JM, Harris IA. Cryotherapy after total knee arthroplasty a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2010 Aug;25(5):709-15. doi: 10.1016/j.arth.2009.07.010. Epub 2009 Sep 2.

Reference Type BACKGROUND
PMID: 19729279 (View on PubMed)

Barry S, Wallace L, Lamb S. Cryotherapy after total knee replacement: a survey of current practice. Physiother Res Int. 2003;8(3):111-20. doi: 10.1002/pri.279.

Reference Type BACKGROUND
PMID: 14533367 (View on PubMed)

Provided Documents

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Document Type: Informed Consent Form

View Document

Other Identifiers

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WRNMMC-2020-0310

Identifier Type: -

Identifier Source: org_study_id

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