Studies Referenced:
Halley Orthopedics, “X10™ Passive Range of Motion Feasibility Study.” Copyright ©2013
Cochrane Collaboration, “Continuous Passive Motion Following Total Knee Arthroplasty in People with Arthritis.” Published by John Wiley & Sons, Ltd. Copyright ©2014.

There was great hope at one time for Continuous Passive Motion
In the 1970’s & 80’s machines called CPM’s (Continuous Passive Motion) were developed to try to aid in knee replacement recovery. Doctors used CPM’s because the concept of early motion after knee replacement made sense. Since then many studies have evaluated their effectiveness. Results both in the short and long terms were controversial, conflicting and in the end unimpressive. These conclusions are not surprising. Even so you may still see CPM’s in use today by some doctors and hospitals. Drew Logue from Advanced Physical Therapy describes his own use of a CPM machine for a football injury when he was younger, and how it compares to the X10 that he uses daily with knee replacement patients in this video clip

X10™ Computer Controlled PMKR: Pressure Modulated Knee Rehabilitation
Regaining passive range of motion (ROM[1]). During the first few days and weeks post TKA[2] there is a golden opportunity to take action and avoid a life-long restriction in range of motion. To take advantage of this opportunity it is necessary to extend and flex the leg with just enough pressure to naturally “pump” fluid from the periarticular[3] tissue. This process will expel the fluid that contains the seeds (Fibroblasts[4]) that will develop into scar tissue. The critical zone in which to accomplish this is less than one degree in size, right at the edge of comfortable movement. Applying too much pressure will move the leg beyond this small region and cause the fluids in the knee to become overly compressed, and can cause intense pain. Applying too little pressure will not move the leg enough, is ineffective in squeezing out the fluid, and is in general non-productive use of the patient’s time. Only the patient, listening to his own body, knows the maximum amount of pressure with which he is comfortable. Only with movement within these very tight angles can fluid be expelled from the region, and range of motion regained.

he X10 accomplishes this goal of productive early movement after surgery. Extremely sensitive patented pressure technology puts control over the amount of pressure exerted on the leg into the hands of the patient. The patient sets the maximum pressure he is comfortable with, and then can focus on making rapid gains in range of motion without fear of sharp or excessive pain. As the patient achieves increases in range of motion she adjusts the pressure as frequently as needed to continue to work within her own unique pain threshold. Patients do not waste their valuable rehab time with motion that has become too easy. Instead they are able to make each session on the X10 highly productive.
CPM machines do not possess the necessary technology to work within the narrow, very precise window of effectiveness, where meaningful gains in ROM can occur. CPM parameters are set by the caregiver; it is very difficult to properly set up a patient in a CPM device. The motion alternates between two fixed angles with very little opportunity for improvement. This often results in spending valuable time on ineffective movement, time that could be better applied elsewhere. There is also the potential to aggravate the knee with excessive motion beyond the pain threshold, setting back the patient’s recovery.

Regaining Strength Leads to Active Range of Motion
Achieving passive normal ROM is only the first step in a full recovery. This must be followed by muscle strengthening to achieve active ROM. The X10™ has three very important strengthening components: strength at end of stroke, eccentric strengthening, and concentric strengthening.

Patients almost universally dislike CPM machines; they are often compared to torture devices. Darlene shares her experience with both a CPM machine and X10 for her TKA recovery in this video.

“What I dread, more than surgery, is having to strap my leg into the continuous passive motion machine for six hours a day when I get home from the hospital. While you’re flat on your back staring at the ceiling, the monotonous motion machine bends your leg, it straightens your leg. Bend. Straighten. Bend. Straighten. Six hours of this. The police should strap suspects into these things. They’ll confess to anything.”
S. Lopez, LA Times

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