Issue 25-2, 2026

Review

https://doi.org/10.38025/2078-1962-2026-25-2-91-98

Local Cryotherapy after Total Knee Arthroplasty: Which Method to Choose? A Literature Review

View article (Download PDF file)



Download XML file

ORCIDDmitry I. Kazantsev1,*, ORCIDAlexander A. Ochkurenko2, ORCIDVladimir A. Peleganchuk1, ORCIDYuri M. Batrak1

1Federal Center of Traumatology, Orthopedics and Endoprosthetics, Barnaul, Russia
2Priorov Central Institute for Trauma and Orthopaedics, Moscow, Russia


ABSTRACT

INTRODUCTION.  Following total knee arthroplasty, various methods of local cryotherapy are employed ranging from traditional ice packs to specialized temperature-controlled devices. However, despite the wide array of existing cold therapy modalities, the efficacy of local cryotherapy remains controversial due to the heterogeneity of local therapy protocols.

AIM.  To identify scientific evidence on local cryotherapy, synthesize findings, and define optimal cryotherapy parameters.

MATERIALS AND METHODS.  Literature searches were performed on February 1, 2024 in CyberLeninka, eLibrary.RU, PubMed, and Cochrane databases. Of 664 studies identified, 18 met inclusion criteria. The study period is February – June 2024.

MAIN CONTENT OF THE REVIEW.  Evidence-based local cryotherapy after knee arthroplasty requires maintaining skin temperature at 10–15 °C for ≥ 30 minutes, with intra-articular temperature < 30 °C. Early initiation post-surgery and protocol individualization based on cryogen thermophysical properties are critical for efficacy. While advanced cryodevices show promise, current data reveal no conclusive superiority over traditional ice-pack therapy.

CONCLUSION.  Standardized cryotherapy protocols remain to be established. Optimizing safety and clinical outcomes necessitates cryogen-specific adjustments of exposure duration/frequency. Implementing temperature-controlled protocols may reduce methodological heterogeneity and improve reproducibility.


KEYWORDS: local cryotherapy, total knee arthroplasty, cryotherapy parameters, temperature control

FOR CITATION: Kazantsev D.I., Ochkurenko A.A., Peleganchuk V.A., Batrak Yu.M. Local Cryotherapy after Total Knee Arthroplasty: Which Method to Choose? A Literature Review. Bulletin of Rehabilitation Medicine. 2026; 25(2):91–98. https://doi.org/10.38025/2078-1962-2026-25-2-91-98 (In Russ.).

FOR CORRESPONDENCE:

Dmitry I. Kazantsev, E-mail: dmitry.kazantsev@inbox.ru, 297501@mail.ru


References:

  1. Adie S., Kwan A., Naylor J.M., et al. Cryotherapy following total knee replacement. Cochrane Database Syst Rev. 2012; 9: CD007911. https://doi.org/10.1002/14651858.CD007911.pub2
  2. Thacoor A., Sandiford N.A. Cryotherapy following total knee arthroplasty: What is the evidence? J Orthop Surg (Hong Kong). 2019; 27(1): 2309499019832752. https://doi.org/10.1177/2309499019832752
  3. Krampe P.T., Bendo A.J.P., Barros M.I.G., et al. Cryotherapy in Knee Arthroplasty: Systematic Review and Meta-Analysis. Ther Hypothermia Temp Manag. 2023; 13(2): 45–54. https://doi.org/10.1089/ther.2022.0043
  4. Liu M.M., Tian M., Luo C., et al. Continuous cryotherapy vs. traditional cryotherapy after total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Front Surg. 2023; 9: 1073288. https://doi.org/10.3389/fsurg.2022.1073288
  5. Wyatt P.B., Nelson C.T., Cyrus J.W., et al. The Role of Cryotherapy After Total Knee Arthroplasty: A Systematic Review. J Arthroplasty. 2023; 38(5): 950–956. https://doi.org/10.1016/j.arth.2022.12.004
  6. Niu R.H., Hou X.F., Chang F., et al. A reassessment of existing systematic reviews evaluating the effectiveness of cryotherapy in patients following total knee arthroplasty. Ann Med. 2025; 57(1): 2512432. https://doi.org/10.1080/07853890.2025.2512432
  7. Jutte L.S., Merrick M.A., Ingersoll C.D., et al. The relationship between intramuscular temperature, skin temperature, and adipose thickness during cryotherapy and rewarming. Arch Phys Med Rehabil. 2001; 82(6): 845–850. https://doi.org/10.1053/apmr.2001.23195
  8. Bugaj R. The cooling, analgesic, and rewarming effects of ice massage on localized skin. Phys Ther. 1975; 55(1): 11–19. https://doi.org/10.1093/ptj/55.1.11
  9. Bleakley C., McDonough S., MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004; 32(1): 251–261. https://doi.org/10.1177/0363546503260757
  10. Ibrahim T., Ong S.M., Saint Clair Taylor G.J. The effects of different dressings on the skin temperature of the knee during cryotherapy. Knee. 2005; 12(1): 21–23. https://doi.org/10.1016/j.knee.2004.02.006
  11. Harris E.D. Jr., McCroskery P.A. The influence of temperature and fibril stability on degradation of cartilage collagen by rheumatoid synovial collagenase. N Engl J Med. 1974; 290(1): 1–6. https://doi.org/10.1056/NEJM197401032900101
  12. Woolley D.E., Evanson J.M. Collagenase and its natural inhibitors in relation to the rheumatoid joint. Connect Tissue Res. 1977; 5(1): 31–35. https://doi.org/10.3109/03008207709152607
  13. MacAuley D. Ice therapy: How good is the evidence? Int J Sports Med. 2001; 22(5): 379–384. https://doi.org/10.1055/s-2001-15656
  14. Kennet J., Hardaker N., Hobbs S., et al. Cooling efficiency of 4 common cryotherapeutic agents. J Athl Train. 2007; 42(3): 343–348.
  15. Belsey J., Gregory R., Paine E., Faulkner J. Skin temperature of the knee was effectively reduced when using a new continuous cold-flow cryocompression device: a randomised controlled crossover trial. Physiotherapy. 2024; 123: 11–18. https://doi.org/10.1016/j.physio.2023.12.001
  16. Selfe J., Hardaker N., Whitaker J., et al. Thermal imaging of an ice burn over the patella following clinically relevant cryotherapy application during a clinical research study. Phys Ther Sport. 2007; 8: 153–158. https://doi.org/10.1016/j.ptsp.2007.04.001
  17. Guillot X., Tordi N., Laheurte C., et al. Local ice cryotherapy decreases synovial interleukin 6, interleukin 1β, vascular endothelial growth factor, prostaglandin-E2, and nuclear factor kappa B p65 in human knee arthritis: a controlled study. Arthritis Res Ther. 2019; 21(1): 180. https://doi.org/10.1186/s13075-019-1965-0
  18. Oosterveld F.G., Rasker J.J. Effects of local heat and cold treatment on surface and articular temperature of arthritic knees. Arthritis Rheum. 1994; 37(11): 1578–1582. https://doi.org/10.1002/art.1780371104
  19. Kim Y.H., Baek S.S., Choi K.S., et al. The effect of cold air application on intra-articular and skin temperatures in the knee. Yonsei Med J. 2002; 43(5): 621–626. https://doi.org/10.3349/ymj.2002.43.5.621
  20. Oosterveld F.G., Rasker J.J., Jacobs J.W., et al. The effect of local heat and cold therapy on the intraarticular and skin surface temperature of the knee. Arthritis Rheum. 1992; 35(2): 146–151. https://doi.org/10.1002/art.1780350204
  21. McMaster W.C. Cryotherapy. Phys Sportsmed. 1982; 10(11): 112–119. https://doi.org/10.1080/00913847.1982.11947373
  22. McMaster W.C. A literary review on ice therapy in injuries. Am J Sports Med. 1977; 5(3): 124–126. https://doi.org/10.1177/036354657700500305
  23. Graham C.A., Stevenson J. Frozen chips: an unusual cause of severe frostbite injury. Br J Sports Med. 2000; 34(5): 382–383. https://doi.org/10.1136/bjsm.34.5.382
  24. Karunakara R.G., Lephart S.M., Pincivero D.M. Changes in forearm blood flow during single and intermittent cold application. J Orthop Sports Phys Ther. 1999; 29(3): 177–180. https://doi.org/10.2519/jospt.1999.29.3.177
  25. Ho S.S.W., Coel M.N., Kagawa R., et al. The effects of ice on blood flow and bone metabolism in knees. Am J Sports Med. 1994; 22: 537–540.
  26. Warren T.A., McCarty E.C., Richardson A.L., et al. Intra-articular knee temperature changes: ice versus cryotherapy device. Am J Sports Med. 2004; 32(2): 441–445. https://doi.org/10.1177/0363546503258864
  27. Dahlstedt L., Samuelson P., Dalén N. Cryotherapy after cruciate knee surgery. Skin, subcutaneous and articular temperatures in 8 patients. Acta Orthop Scand. 1996; 67(3): 255–257. https://doi.org/10.3109/17453679608994683
  28. Healy W.L., Seidman J., Pfeifer B.A., et al. Cold compressive dressing after total knee arthroplasty. Clin Orthop Relat Res. 1994; 299: 143–146.
  29. Ivey M., Johnston R.V., Uchida T. Cryotherapy for postoperative pain relief following knee arthroplasty. J Arthroplasty. 1994; 9(3): 285–290. https://doi.org/10.1016/0883-5403(94)90083-3
  30. Demoulin C., Brouwers M., Darot S., et al. Comparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty. Ann Phys Rehabil Med. 2012; 55(4): 229–240. https://doi.org/10.1016/j.rehab.2012.03.004
  31. Su E.P., Perna M., Boettner F., et al. A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br. 2012; 94(11 Suppl A): 153–156. https://doi.org/10.1302/0301-620X.94B11.30832
  32. Bech M., Moorhen J., Cho M., et al. Device or ice: the effect of consistent cooling using a device compared with intermittent cooling using an ice bag after total knee arthroplasty. Physiother Can. 2015; 67(1): 48–55. https://doi.org/10.3138/ptc.2013-78
  33. Schinsky M.F., McCune C., Bonomi J. Multifaceted Comparison of Two Cryotherapy Devices Used After Total Knee Arthroplasty: Cryotherapy Device Comparison. Orthop Nurs. 2016; 35(5): 309–316. https://doi.org/10.1097/NOR.0000000000000276
  34. Ruffilli A., Castagnini F., Traina F., et al. Temperature-Controlled Continuous Cold Flow Device after Total Knee Arthroplasty: A Randomized Controlled Trial Study. J Knee Surg. 2017; 30(7): 675–681. https://doi.org/10.1055/s-0036-1593874
  35. Levy A.S., Marmar E. The role of cold compression dressings in the postoperative treatment of total knee arthroplasty. Clin Orthop Relat Res. 1993; 297: 174–178.
  36. Morsi E. Continuous-flow cold therapy after total knee arthroplasty. J Arthroplasty. 2002; 17(6): 718–722. https://doi.org/10.1054/arth.2002.33562
  37. Kuyucu E., Bülbül M., Kara A., et al. Is cold therapy really efficient after knee arthroplasty? Ann Med Surg (Lond). 2015; 4(4): 475–478. https://doi.org/10.1016/j.amsu.2015.10.019
  38. Gibbons C.E., Solan M.C., Ricketts D.M., et al. Cryotherapy compared with Robert Jones bandage after total knee replacement: a prospective randomized trial. Int Orthop. 2001; 25(4): 250–252. https://doi.org/10.1007/s002640100227
  39. Tauseef A., Mannan M., Shrivastava N., et al. A Prospective Comparative Study of Postoperative Pain and Functional Outcomes With and Without Cryotherapy Following Total Knee Arthroplasty. Cureus. 2025; 17(6): e85227. https://doi.org/10.7759/cureus.85227
  40. Lee B., Yoon D., Yim J. Effects of an Early Exercise Program with Cryotherapy on Range of Motion, Pain, Swelling, and Gait in Patients with Total Knee Arthroplasty: A Randomized Controlled Trial. J Clin Med. 2024; 13(5): 1420. https://doi.org/10.3390/jcm13051420
  41. Wittig-Wells D., Johnson I., Samms-McPherson J., et al. Does the use of a brief cryotherapy intervention with analgesic administration improve pain management after total knee arthroplasty? Orthop Nurs. 2015; 34(3): 148–153. https://doi.org/10.1097/NOR.0000000000000143
  42. Dundon J.M., Rymer M.C., Johnson R.M. Total patellar skin loss from cryotherapy after total knee arthroplasty. J Arthroplasty. 2013; 28(2): 376.e5–376.e7. https://doi.org/10.1016/j.arth.2012.05.024
  43. Yang.L, Zhan Y.F., Zhai Z.J., et al. Mechanisms and parameters of cryotherapy intervention for early postoperative swelling following total knee arthroplasty: A scoping review. J Exp Orthop. 2025; 12(1): e70197. https://doi.org/10.1002/jeo2.70197
  44. Khoshnevis S., Craik N.K., Diller K.R. Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee Surg Sports Traumatol Arthrosc. 2015; 23(9): 2475–2483. https://doi.org/10.1007/s00167-014-2911-y
  45. Electrophysical agents contraindications and precautions: an evidence-based approach to clinical decision making in physical therapy. Physiother Can. 2010; 62(5): 1–80. https://doi.org/10.3138/ptc.62.5
  46. Speck M., Jakob R., Brinkmann K.E. Blood loss after total knee arthroplasty in relation to positioning: 70j flexion v extension [Abstract]. J Bone Joint Surg Br. 1999; 81(Suppl 1): 245.
  47. Liu Yu., Zhang Nanxin, Dai Liqun, et al. Meta-analysis of the effectiveness of cold therapy after total knee arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1443–1448.
  48. Mackie M., Barton K.I., Sokol-Randell D., et al. The use of biomarkers to quantify clinical response to total knee arthroplasty interventions: a systematic review. J Am Acad Orthop Surg Glob Res Rev. 2024; 8(3): e2300202. https://doi.org/10.5435/JAAOSGlobal-D-23-00202



Creative Commons License
The content is available under the Creative Commons Attribution 4.0 License.

©


This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.