CPM machine

[alexandra]

Alex has had her knee operated on on Weds and the rehab begins.  It seems that CPM (continuous passive motion) machines are very well regarded.  Anyone got an old one for sale?  We are in Bournemouth area but anywhere in the country would be considered.  Also looking for a Donjoy playmaker type of adjustable limited movement knee brace.  Thanks.
Andrew

[Heather M.]

CPM's are considered medical devices, at least in the US.  Private citizens don't own them as a general rule.  I looked into buying one and it was about $8000 for a USED one.  The costs are so prohibitive that it really doesn't make sense to buy one, even for someone like me (scar tissue problems).  I'd suggest getting a prescription from the doctor and renting one from a medical supply house.

BTW, even if I had almost $10K that I didn't know what to do with, I couldn't buy a CPM.  The sellers have to verify the medical license of the purchaser....every once  in awhile you see one on ebay, but it is old and ratty and usually sold as is--no guarantees on function.

Talk to your daughter's OS and see if he/she can write a script.  Depending on what procedure she had, the CPM may be appropriate.  It seems like many patients on HMO's (health management organizations--cheapskate insurance companies with more regulations than medical sense, not to put too fine a point on it) or national health care systems--anywhere that the healthcare expenditures are rigorously rationed--people don't seem to get CPM's unless they really fight for them.  My insurance company wouldn't pay for one for more than a week...mind you, if I hadn't had a CPM for over 10 weeks I would have been facing the need for another surgery almost immediately...they don't care.  The bean counters have their list of approved procedures and medical devices, and they substitute their policy and judgment for that of the orthopedic surgeons.  Very frustrating!

Heather

PS By the way, CPM's are proven to be most effective when started immediately upon surgery--I woke up in one last surgery, right in post-op.

[alexandra]

Dear Heather,
   Thanks for the reply. Alex had the plaster off yesterday and is now in a ROM brace. We asked both the OS and the physio about CPM and the OS said there was not much point as she should be moving it herself now - the ROM is set to 45deg and the physio said more or less the same although she agreed that CPM is a generally a good thing.  In UK the NHS (National Health Service) is supposed to provide everything you need and the medical staff do their best.  However the bureaucratic and administrative inefficiency is legendary and they (the administrators) are laying people off left right and centre in order to save money.  This means that the people working in the NHS are stressed and rushed, you seldom see the same person twice, even the OS consultant is different every time and you just hope that they have the right notes!

  Anyway on the subject of CPM I phoned a manufacturer in UK and they will rent them to people for a couple of hundred pounds a month - it was expensive - but there was no clause saying that you had to be medically qualified.  You will almost certainly have to sign a waiver saying that the machine if for experimental purposes only etc. and the the company is not liable etc.  We haven't gone down that route yet as Alex is going to see how much movement she can get by herself.

  On the general subject of CPM machines, especially the knee ones, which is what we are interested in, there seems to be very little to them apart from the electronic motor control, which is not that expensive or difficult if your are an engineer (I am).  You could make one from plywood (sufficiently thick to provide the strength in the arms) I feel sure and as a first model it could be powered by the patient by either pulling a rope or a handle - a litttle tedious but cheap and simple.  It does seem that the benefits of CPM (I'm not an expert - far from it, I've just read about it on the internet) are being excluded from people's treament plans owing to the high cost / unavailablity of the machines.  This leads to the question: "Are the machines expensive  because there is small demand for them or is there small demand for them because they are so expensive?"  Kneeguru shows that there are enough bad knees!

  A friend of ours (Alex is my partner) knows someone (in UK) who had a knee injury and had a CPM machine and she made a remarkably rapid recovery and was back skiing in a couple of months.  It seems, superficially at least, that the cost of CPM machines is leading to many wasted opportunities.  Of course I dare say that the legal profession and a certain suing culture also contributre to the high price of the machines.

  Thanks again for the reply and until Alex decides to log on and contribute it seems that I will have to continue as "Alexandra".

  Very best wishes Heather for a full recovery,
  Andrew

[Jaci]

Andrew,

All CPM's are not created equal. There actually is a fair amount of engineering (position & length of lever arms, axis of motion, so on) involved so as not to unduely stress the knee joint. I've used a couple different styles. One type bent the knee by applying force to the foot and lower part of the leg. This is the most commonly seen mechanism. I found this type to be very uncomfortable, it actually irritated my knee. I had the technician bring me a different machine and re-adjust it because it was so uncomfortable. The new machine wasn't any better.

For subsequent surgeries I used a different style-- one that bends the knee by lifting at the thigh-- what a difference!!! I was fairly comfortable using the machine, and most importantly it didn't irritate my knee. This machine has a proprietary mechansim that was developed by an ortho surgeon. Prior to surgery I was completely dreading using the CPM again, but later discovered that it was the design of the CPM, not just CPMs in general, that made all the difference.

Supply and demand probably comes into play with the costs. In the US at least, insurance companies will do everything they can in attempt to keep costs down, including refusing to pay for certain therapies or devices. They will categorize it as 'experimental' even though there is plenty of medical data to support using them. To me it seems sort of odd that they will refuse to pay for something in the short run that in the long run may prevent repeat procedures and or prolonged physical thereapy. I guess they're willing to take that chance.

I hope Alex is back on her feet in no time.

Jaci

[connie36]

It's a catch-22.

Right now I have excellent medical coverage, low copays, 100% coverage of surgeries, functional knee braces, etc.   I think if my surgeon prescribed a CPM, they'd cover it 100%.    BUT - I've had 4 surgeries so far and have never had a CPM or felt that I needed one.    In fact, comparing results with friends who had the same type of surgery WITH a CPM - we were pretty much identical in terms of ROM gains and long term success.   

So for basic surgeries like I've had - both ACL's, meniscus repair, etc. - I personally feel that a CPM machine would have been a waste of money.   With something more major, maybe I'd need one.   But I just feel like, if my insurance was spending tons of money on a CPM machine for every knee surgery out there - would my rates be even worse?   Would I be paying huge sums of money out of pocket like some of my friends have had to to in order to have surgery?   I'd rather they continue to cover PT and keep copays reasonable and only prescribe me a CPM machine if I really need one or started to run into ROM issues, instead of with every surgery "just in case". 

[Jaci]

First off, Connie, I completely understand what you're saying that there may be some situations a CPM could be considered a waste of money.  However, I do think it's important to say that many durable medical equipment providers bill CPM rentals at around $20-25 per day. So, while it's not cheap, I'm not sure I would call it tons of money, either. And, yes, you could make the case that it adds up over an insurers' customer base.

I would hate for someone who might benefit from using a CPM to decide not to based on incomplete info about the cost. Plus, CPM has been proven to be of value after procedures like ACL construction and many OS recommend them in such cases. So for those folks-- check with multiple equipment providers and remember that everything is negotiable. Some providers will offer a significant discount for self-pay or cash patients.

Jaci
 

[connie36]

I agree too, that it's totally worth the money in other situations.   But I think it is something that's probably best decided on a case by case basis - for people with a history of scar tissue problems, undergoing a very complicated/invasive procedure, etc.

[judojay]

Alex has had her knee operated on on Weds and the rehab begins.  It seems that CPM (continuous passive motion) machines are very well regarded.  Anyone got an old one for sale?  We are in Bournemouth area but anywhere in the country would be considered.  Also looking for a Donjoy playmaker type of adjustable limited movement knee brace.  Thanks.
Andrew

Hi I am in Portsmouth and have a Mueller Pro Hinged Deluxe Brace similar to the Playmaker but much better (see peoples views on other parts of the forum) I've worn it once and its like new and is an extra large. It cost £70 a month ago if your interested make me an offer.(You will find it on line at WWW.Physio-room.com

[Ronxski]

Hi all, I saw this post for re: CPM and had to check it out. It was a year ago January that I started PT for a trimmed medial meniscus. 2 weeks after surgery the first thing they did was put me on the CPM , the one like Jaci said was good. Under the thigh.
It was a fantastic machine! I couldn't wait to get to my sessions to get ROM back. They set up the minimum guidelines then  gave me the control and it was upto me to set the degree of bend I felt comfortable with. Mindful that they said there will be some discomfort as you break up the adhesions and get flex back. It was great to see the digital display showing progress daily. Not only for flex but for extension into the negative numbers. It's just as important to get that leg straight again.

If I had not had use of that machine it would have set me back a long ways. They use it a lot at the Rehab center.
My buddy had meniscus repair and ACL PCL surgery several years ago and he woke up with the CPM doing it's thing. He loved it as well.
So if you get a chance to use it. Consider yourself fortunate.  Ron

[Anya]

I agree - CPM is great!! 

I use it now - post op after ACLR and menisectomy and it's great - makes sure my ROM is back and also (per my experience) works as a painkiller (the PA I saw after the surgery agreed with it, as it is natural for the knee to move).

I wish I had it 9 yrs ago when I broke all the big bones on my other leg (femur, fibula and tibia) into pieces.  I was not in a cast or immobiliser after the surgery as I had hardware inside, but because i did not move my leg for a while after the surgery, it was very stiff and it took me months to get the ROM back (and although there was nothing wrong with the knee, but I could not bend it AT ALL)!!  With the CPM that could have been avoided.

[Teresa_S]

I bought my CPM machine on ebay. I was lucky at the time, as some rental company was dispersing or had gotten all new machines, or something. Anyway paid $300, wich was a lot cheaper than two months rental. Was happy to have it, and should have slept in it more often. Teresa

[alexandra]

Dear JudoJay,
  Thanks for the offer of the knee brace.  I got a Breg one from U.S.A. and we are using that.  The N.H.S. had Alex down for one and would have supplied one but because we had our own (just in case theirs had not been ordered, forms got lost etc.) they were very happy to use that and theirs was never mentioned again.  It was Poole Hospital and the chap said that they normally use DonJoy braces, so it seems that you can get them on the N.H.S.  Alex spent the first 20 days in stright leg plaster then was put into the brace.  Alex is getting movement back and is at about 50 degrees aiming for 90 degrees in another 10 days.  The P.T. at Swanage Hospital is excellent and keen on ROM and quad exercises, so I feel that we have lucked in there.  She said that CPM would not really be needed if the do it yourself exercises work, which of course they will, it is just a question of time.  The impression I get is that there is not much of a pro CPM movement in U.K. as the machines are not readily available - especially on NHS.  Although a friend of a friend (in UK) who had one spoke very highly of it and she was mobile again in no time.
  Contacted a U.K. manufacturer of CPM machines and they do hire them out but it was a couple of hundred pounds for a fortnight.  Will post exact figures when I find them.
  Thanks everyone for the replies,
  Andrew.