Health Technology Review

Cryotherapy Following Nonknee Arthroplasty

What Is the Issue?

• Joint replacement surgeries remain among the highest-volume inpatient procedures in Canada. This major operation replaces a damaged joint with an artificial implant to relieve severe pain and restore mobility. While joint replacement can significantly improve a patient's quality of life, the recovery phase involves acute pain and swelling at the surgical site that requires postoperative care to improve recovery.

• Cold therapies, such as ice packs, are part of the standard postoperative care and recovery to reduce swelling, inflammation, and pain. Cryotherapy devices are specialized interventions for cold therapy that are designed to offer lower and/or more consistent temperatures than conventional ice packs. However, the clinical effectiveness of cryotherapy after surgical replacement of joints other than the knee is unclear.

• This rapid review was prepared in response to a request for evidence to support decision-making around the use of cryotherapy after nonknee arthroplasty.

What Did We Do?

• Canada’s Drug Agency conducted a rapid review to identify and summarize evidence that evaluated the clinical effectiveness of cryotherapy compared with standard postoperative care in adult patients undergoing nonknee arthroplasty.

• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published between January 1, 2023, and August 11, 2026.

What Did We Find?

• We found 1 systematic review that evaluated cryotherapy postoperatively in adult patients undergoing total hip arthroplasty and 1 nonrandomized clinical trial that evaluated cryotherapy following carpometacarpal arthroplasty.

• We did not find studies on the clinical effectiveness of cryotherapy versus standard of care for shoulder, elbow, wrist, or ankle joint arthroplasties.

• Compared with standard of care, cryotherapy may be associated with improved pain during the first 2 postoperative days following total hip arthroplasty and 2 weeks after carpometacarpal arthroplasty without increasing the risk of adverse events.

• The included studies did not detect statistically significant differences between cryotherapy and control groups for analgesic use, blood loss, joint function, adverse events, or hospital length of stay.

• The clinical evidence summarized in this rapid review is of low to moderate quality, with substantial concerns regarding selection bias, lack of randomization, intervention masking, and generalizability.

What Does This Mean?

• Health care professionals and decision-makers can use this evidence to inform decisions around the use of cryotherapy after hip and carpometacarpal joint replacements. Low-certainty evidence suggests that cryotherapy might offer short-term pain relief, but patients might not experience benefits in other clinical outcomes.

• Well-designed studies with proper reporting are needed to confirm the clinical effectiveness of cryotherapy versus other cold therapies.

Research Question

What is the clinical effectiveness of cryotherapy devices for postoperative care in adults who have undergone nonknee joint arthroplasty?

Context and Policy Issues

What Are Joints and How Are Joint Injuries Managed?

In the human body, the areas where bones connect are called joints, which are formed by bones, ligaments, and tendons. Joints function as an axis for movement and can be categorized based on their movement capabilities.¹ Different types of joints include freely movable joints (e.g., elbows and hips) and partially movable joints (e.g., facet joints and intervertebral disks). Immovable or fibrous joints are flexible in newborns but fuse together in adult life to prevent movement (e.g., the bones in the skull).²

All joints are prone to illness like arthritis and trauma or injuries such as sprains or dislocations that can result in pain and disruption of the joint function.^3,4 Arthritis is a chronic disease characterized by joint inflammation, and in Canada, approximately 20% of the population lives with its effects.⁵

The management of an ailing joint can include drug or nondrug approaches, but a joint that does not improve with conservative treatments and is severely damaged might need surgical joint replacement (i.e., joint arthroplasty).^6-8

Joint Arthroplasty and Postsurgical Care

Joint arthroplasty is a surgical procedure performed to alleviate pain and restore joint function by partially or totally replacing a damaged joint with a prosthetic implant. This procedure involves tissue trauma and bone resection, leading to an inflammatory response and postoperative pain.^9,10 Despite its clinical effectiveness in reducing pain and improving function and quality of life, joint arthroplasty is also associated with postoperative complications that might require revision surgery and could impact patients’ clinical outcomes. Complications can include blood clots, infections, venous thromboembolism, range of motion reduction, nerve injury, wound complications, ischemia-reperfusion injury, long hospital length of stay, and implant failure.^11-13

The most common arthroplasty procedures performed in Canada include total hip arthroplasty (THA) and total knee arthroplasty (TKA). In 2024, a total of 79,346 THA procedures and 95,896 TKA procedures were performed in Canada, costing $1.64 billion to the health care systems. Overall, most patients were female, with an average age of 65 years and osteoarthritis as the primary diagnosis. Infection was the primary cause of a revision surgery, which was associated with a mean hospital length of stay of 9.3 days, compared to 3.6 days for primary surgery.¹⁴ Other joints that may also require replacement include shoulder, elbow, hand, ankle, and the thumb (carpometacarpal joint).

To alleviate pain and swelling after joint arthroplasty, the standard of care includes pain medication, cold, and compression.¹⁵ Prescribed pain medications vary and can include acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, opioids, spinal and/or epidural analgesia, regional nerve blocks, and/or local anesthetics.¹⁶ Standard methods to apply cold (i.e., bag of ice, ice packs, ice wrapped in a towel, gel packs) can be offered either alone or in combination with compression for 15 to 20 minutes several times a day. Exposing surgical sites to cold temperatures aims to alleviate inflammation and tissue damage by numbing, constricting blood vessels, and slowing down cellular metabolism in the surgical area.^17-19 However, the cold intensity of standard methods is inconsistent over time, and ice must be replaced as it melts.^20-22

Cryotherapy

Another method for the use of cold in postsurgical care, called cryotherapy, typically uses a pump system with tubes connecting to a protective layer that goes against the surgical area on the body. The cryotherapy system pumps either refrigerated, cooled air or ice-cold water from a cooler compartment through the tube into a pad on the surgical area, which circulates and returns to the cooler compartment to be cooled again. This circulation method is designed to offer steady cooling temperatures for a prolonged time.^23-25

The application of cryotherapy has evolved with the use of cold sprays, liquid nitrogen, high-pressure cold CO₂, electronic cooling systems, cold compression brace or a computer-assisted cryotherapy device, and whole-body cryotherapy.^26,27 Cold temperatures with cryotherapy can range from –140°C to 18°C, with sessions that can last minutes to hours.^28-31

Although it has been suggested that lower temperatures and/or extended cooling periods can reduce postsurgical pain and swelling,¹⁷ excessive use of cryotherapy can cause skin irritation, frostbite, inflamed swollen patches, blistering, or peripheral nerve injuries.²⁴ Its use could also be limited in the presence of specific conditions (i.e., Raynaud disease, cold urticaria, cryoglobulinemia, multiple myeloma).³²

Cryotherapy in Canada

In Canada, cryotherapy may be available for postoperative orthopedic care through hospitals and rehab clinics, and its use varies across provinces. According to the National Physician Database — Utilization data, a total of 276,411 cryotherapy procedures were provided during 2023–2024 in Canada, which represents a total cost of CA$5,015,900, though the indication for cryotherapy use across Canada is not specified.³³

Given the volume of joint arthroplasty performed in Canada and the ongoing efforts to optimize postoperative recovery and decrease opioid consumption, there is an interest in understanding the clinical effectiveness of cryotherapy following nonknee arthroplasty.

Why Is It Important to Do This Review?

There is interest in evaluating postoperative care options for individuals following joint arthroplasty to support recovery and reduce harms. Joint arthroplasty is among the most common surgeries performed across Canada; just in 2024–2025, more than 175,000 hip and knee arthroplasties were performed.¹⁴ Opioids have been established as part of the recovery plan after joint arthroplasty, although opioid use has generally increased over time, leading to a worldwide opioid crisis.³⁴ In Canada, a total of 57,509 deaths from opioid toxicity occurred between 2016 and 2026.³⁵ A nonopioid therapeutic intervention such as cryotherapy might be beneficial during the postoperative stage, if found to manage pain and swelling that could result in better clinical outcomes. However, uncertainty exists for the clinical effectiveness of cryotherapy devices for nonknee arthroplasty in Canada.

Objective

To support decision-making about the use of cryotherapy for adults following surgical replacement of joints other than the knee, we prepared this rapid review to summarize and critically appraise available evidence regarding the clinical effectiveness of cryotherapy devices compared to standard postoperative care for adults who underwent nonknee arthroplasty.

Methods

An information specialist conducted a customized literature search, balancing comprehensiveness with relevance, of multiple sources and a focused internet search on August 11, 2026. One reviewer screened records and selected studies based on the inclusion criteria presented in Table 1. All included studies were critically appraised by 1 reviewer using 1 critical appraisal tool per study design.^36,37 Appendix 1 presents a detailed description of methods and selection criteria for included studies.

Table 1: Selection Criteria

Summary of Evidence

Quantity of Research Available

This report includes 2 publications^38,39 that met our inclusion criteria and addressed our research question, including 1 systematic review (SR)³⁸ that had a broader inclusion criterion, including TKA and THA primary studies. In this rapid review we report on the characteristics and results from the subset analysis on THA primary studies. Also, we identified 1 prospective, nonrandomized comparative analysis³⁹ in patients undergoing carpometacarpal (CMC) arthroplasty.

Appendix 2 (Figure 1) presents the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)⁴⁰ flow chart of the study selection.

Summary of Study Characteristics

Appendix 3 (Table 2) provides details regarding the characteristics of the included publications.

The SR³⁸ compared cryotherapy with standard of care in a broad joint arthroplasty population and included 3 primary studies on THA. These THA studies were randomized clinical trials, single-centre and conducted in Germany,⁴¹ Japan,⁴² and the Netherlands.⁴³ Detailed study characteristics (e.g., demographics, cryotherapy device brand, and protocols) were extracted from primary studies and presented in this report when possible. One THA primary study was published in German and data abstraction was not done for this primary study. The evaluated interventions in the primary studies included the computer-controlled cooling device Icing System 2000⁴² and the cryocompression Game Ready System,⁴³ which were initiated after surgery. Additional details on the cryotherapy protocols are provided in Table 2. The THA primary studies were published between 1997 and 2012, and 1 study reported receiving funding.⁴³

The CMC study³⁹ was a single-centre study conducted in the US that compared cryotherapy (using the NICE iceless hand and wrist recovery compression system) to ice packs. After surgery, all patients had their hands immobilized with a plaster splint; at this time, the investigator decided which patients would receive cryotherapy under the splint and which patients would apply ice packs over their splints. Participants who received cryotherapy had already agreed before surgery to pay for the additional cost of receiving cryotherapy, making them eligible to be in that group. This study was published in 2026 and the authors did not receive any type of funding.

The 3 THA primary studies^41-43 included adult patients aged 59 to 68 years. In 1 THA study,⁴² 37 were female and 9 were male. In a second primary THA study,⁴³ 18 female and 12 male participants were included. In the CMC study,³⁹ 79% of the patients who required CMC joint arthroplasty were female, with an average age of 58 years.

The authors of the CMC study and SR did not describe how gender or sex were defined and did not report sex or gender identities outside of female and male. The included studies did not provide participant information for other PROGRESS-Plus criteria⁴⁴ such as place of residence, race, ethnicity, culture, language, occupation, religion, education, socioeconomic status, or social capital.

Across relevant THA studies within the SR³⁸ and the CMC study publications,^38,39 the reported outcomes were:

• postoperative pain at day 1 and 2 in 1 THA primary study,⁴¹ and at the 2-week and 6-week postsurgery visits in the CMC study³⁹

• analgesic use (i.e., mepivacaine hydrochloride, diclofenac sodium, and morphine) from 2 THA primary studies during the first 24 to 72 hours after surgery,^42,43 and oxycodone tablets at 2 weeks after surgery in the CMC study³⁹

• blood loss from drainage on day 1 after surgery from 1 THA primary study⁴³ and total blood loss within the first 24 hours after surgery in a second THA primary study⁴²

• joint function, including range of motion-degrees of flexion (with lower values indicating better function) on postoperative day 1 and 2 from 1 THA primary study,⁴¹ and global hand function measured using the single assessment numeric evaluation score (with higher values indicating better function) at the 6-week postsurgery visit from the CMC study³⁹

• hospital length of stay from 1 THA primary study⁴³

• adherence was measured as the number of patients who either used cryotherapy or ice packs for at least 3 or 7 days, and those completing 3 or 7 or more sessions per day in the CMC study³⁹

• adverse events from 2 THA primary studies.^42,43

Summary of Critical Appraisal

The details for the critical appraisal for each publication are provided in Appendix 4 (Table 4, and Table 5).

Systematic Reviews

The included SR³⁸ had several strengths related to reporting and a clearly defined research question and inclusion criteria following the PICO framework, specifying the population, intervention, comparator, and outcomes. The authors followed a prespecified protocol registered in PROSPERO, as well as providing a rationale for including randomized controlled trials (RCTs). The literature search was conducted across multiple databases (e. g., PubMed, Web of Science, the Cochrane Library, Embase, and CINAHL [Cumulative Index to Nursing and Allied Health Literature]). Two independent reviewers screened articles, conducted data extraction, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Although the authors reported the exclusion of articles, they did not provide a reason for exclusion. This limits transparency and makes it difficult to determine whether potentially relevant evidence was excluded systematically or whether exclusions could have introduced selection bias.

At the study level, the authors adequately described the study characteristics (e.g., country, year, sample size, participant characteristics, type of joint arthroplasty, intervention, comparator, and outcomes). A critical factor not reported by the authors of the SR was the cryotherapy protocol for each primary study. This limits the ability to determine whether differences in device characteristics, treatment duration, temperature, compression, or frequency of use contributed to differences between groups. Therefore, the pooled findings for analgesic use and adverse events may combine clinically different interventions and may not be directly applicable to a specific cryotherapy protocol or device used in Canada. The SR disclosed the review authors' funding and conflicts of interest but did not establish that funding sources for the individual included RCTs were systematically reported. This prevents us from assessing a potential financial conflict of interest from the primary studies, which introduces uncertainty regarding the independence of the reported findings.

The statistical methods used in the meta-analysis (MA) were appropriate (e.g., mean differences and risk ratio). The authors assessed individual study-level risk of bias and at the outcome level following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. However, the review did not clearly report whether the risk of bias of individual primary studies was accounted for in the pooled analyses of analgesic use and adverse events. The SR authors did consider study methodology when interpreting the findings by acknowledging the limitations from randomization, allocation concealment, masking, heterogeneity, and unpowered sample sizes. The SR authors did not report on what would constitute a clinically meaningful effect size, which further limits our interpretation of findings.

The authors of the SR³⁸ analyzed publication bias using funnel plots for outcomes containing 10 studies or more. However, because the pooled analyses for analgesic use and adverse events after THA were supported by 2 primary THA studies, publication bias could not be reliably assessed for these outcomes. While not a methodological flaw of the SR in this case, it is unclear whether negative studies were underrepresented.

Nonrandomized Studies

The CMC prospective comparative study³⁹ had some strengths as well as important limitations affecting its internal validity. The study was clearly reported with respect to its objectives, interventions, outcomes, and findings, and the adherence to cryotherapy was specifically assessed. However, several methodological limitations reduce confidence in the observed treatment effects.

The principal limitation is the nonrandomized study design. Patients were not randomly allocated to each study group; instead, participants were selected at the surgeon’s discretion, and participants had preoperatively agreed to cover the cost of the cryotherapy intervention. These factors raise concerns regarding the representativeness and comparability of the study groups and may have introduced selection bias.⁴⁵ In addition, the analyses did not adequately adjust for potential confounding factors. Consequently, differences between groups may reflect baseline patient characteristics, treatment preferences, surgical factors, or other differences rather than the effect of the intervention itself. For example, participants who were able and willing to pay for cryotherapy may have differed systematically from those who were not, and this was not accounted for in the analysis. Therefore, differences in outcomes between groups cannot be confidently attributed to cryotherapy alone.

The lack of intervention masking is an important limitation to this study, though masking patients to the use of a cryotherapy device versus traditional ice packs would have been challenging. Nevertheless, knowledge of the treatment received may have influenced patients’ perceptions of pain relief and their reporting of analgesic use. Although the surgeon was not present during outcome assessment, formal masking of outcome assessors to treatment allocation was not reported. Therefore, the lack of masking introduces a potential risk of bias, particularly for subjective patient-reported outcomes.

The study was conducted in 1 clinic by 1 surgeon, which further limits the generalizability of the findings to other surgeons, institutions, and patient populations.⁴⁶ In addition, reporting of exclusions or losses to follow-up and adverse events was limited, creating uncertainty regarding the potential for attrition or reporting bias.⁴⁷ For instance, 17 of 57 (30%) patients in the CMC arthroplasty group did not complete the global hand function survey at 6 weeks after surgery. This increases the risk that missing data may have influenced the interpretation of findings and introduces the potential for attrition bias. For example, if participants with poorer outcomes were more likely to withdraw, the treatment effect could be overestimated and vice versa; if participants with better outcomes were more likely to withdraw, the effect could be underestimated. Also, the absence of an a priori power calculation limits interpretation of nonsignificant findings. For example, the trend toward significant between-group differences in oxycodone consumption suggests that reduced pain did not clearly translate into reduced analgesic requirements. Furthermore, minimally important differences were not reported for any outcome. It is unclear whether any findings would be considered clinically meaningful.

Overall, the study provides low-certainty evidence (with important risk of selection and/or confounding bias) that supports the potential benefits of cryotherapy post CMC arthroplasty for pain relief. However, the methodological limitations suggest cautious interpretation and reduce confidence in conclusions regarding comparative effectiveness.

Summary of Findings

Table 6 and Table 7 in Appendix 5 include additional details regarding the main study findings.

One SR³⁸ with 3 primary studies^41-43 and 1 nonrandomized study³⁹ provided information on the clinical effectiveness of cryotherapy versus standard of care for adult patients undergoing THA and thumb carpometacarpal arthroplasty.

Postoperative Pain

The authors of the SR³⁸ reported the effect of cryotherapy compared to the control group on pain during postoperative days 1 and 2 from 1 THA primary study. The authors found that when compared to control, cryotherapy was associated with significantly lower levels of pain at both postoperative time points.

The authors of the CMC³⁹ study compared self-reported pain relief between cryotherapy and ice packs at 2 weeks after surgery; the study reported a statistically significant reduction in pain in the cryotherapy group.

Analgesic Use

The authors of the SR³⁸ found no statistically significant difference in the pooled analysis between cryotherapy and standard of care for analgesia use after THA.

The CMC study³⁹ reported a marginal (nonsignificant) trend toward reduction of oxycodone intake in the cryotherapy group compared to ice packs at 2 weeks post-CMC arthroplasty.

Blood Loss

The authors of the SR³⁸ reported no statistical differences between cryotherapy and standard of care in either total blood loss or blood loss from drainage at 24 hours postoperatively.

Joint Function

The authors of the SR³⁸ evaluated the clinical effectiveness of cryotherapy versus standard of care on joint range of motion following THA at postoperative days 1 and 2 based on data from 1 THA primary study. The results show a significantly lower range of motion in the cryotherapy group compared to controls at both time points.

The authors of the CMC³⁹ study compared global hand function scores between cryotherapy and ice packs at the 6-week postsurgery visit and found no differences between group scores.

Length of Hospital Stay

The authors of the SR³⁸ found no statistically significant difference in the length of hospital stay between those who received cryotherapy or control, based on data from 1 THA primary study.

Adherence

The authors of the CMC³⁹ study compared adherence between those using ice packs or cryotherapy. A significantly higher proportion of patients in the cryotherapy group used their device for more than 3 or 7 days compared to the ice pack group. Likewise, the cryotherapy group reported a statistically significantly higher frequency of use, with more patients completing more than 3 or 7 sessions per day.

Adverse Events

The pooled analysis in the SR³⁸ suggests that cryotherapy is not associated with adverse events following THA.

Limitations

Evidence Gaps and Quality Limitations

We found no evidence regarding the clinical effectiveness of cryotherapy versus standard of care in adult patients undergoing shoulder, elbow, wrist, or ankle joint arthroplasties. Therefore, no inferences can be made on the clinical effectiveness of cryotherapy for these nonknee arthroplasties.

The identified evidence base for cryotherapy after THA and CMC arthroplasty was limited in quality and quantity. Although the SR included an MA of outcomes following THA,³⁸ it was not possible to conduct pooled analysis for postoperative pain, blood loss from drainage, total blood loss, range of motion, and hospital length of stay. Consequently, these results are based on single-centre studies and unpowered sample sizes, resulting in considerable uncertainty.

The limited results seen from this rapid review included the SR³⁸ that suggests significantly lower postoperative pain with cryotherapy than standard of care on postoperative days 1 and 2 after THA, although with a decreased range of motion during the same window of time. However, assessments were not conducted daily from the surgical day until hospital discharge, or after hospital discharge. In addition, evidence regarding analgesic use was limited to 72 hours after surgery in the SR³⁸ (data from 2 primary THA studies^42,43) and at 2 weeks after surgery in the CMC study.³⁹ Consequently, it is unclear whether the reduction in analgesic use persists outside these time points or over a longer period of time. Also, these findings should be interpreted with caution due to the short follow-up period precluding us from assessing consistency and durability of these effects.

A total of 3 primary studies contributed to the SR findings for cryotherapy use after THA; thus, the evidence base even for the 2 outcomes with pooled findings (adverse events and analgesic use after THA) remains limited. The authors of the SR also noted methodological limitations of the 3 primary THA studies; 2 were assessed to be at high risk of bias and 1 had some concerns, while the certainty of the evidence for all reported outcomes for the THA studies was assessed to be either low or very low.

Two of the THA primary studies^42,43 identified by the SR conducted a per-protocol analysis, which reflects 1 potential methodological limitation. In 1 THA primary study,⁴³ 1 patient in the control group requested to receive the intervention, 2 patients in the intervention group had excessive perioperative blood loss (which was an exclusion criterion), and 1 patient presented discomfort when urinating; these 4 patients were not included in the analysis. In the second THA primary study,⁴² cryotherapy was suspended in 1 patient who experienced discomfort as a result of cooling the surgical area. Because patients were excluded after randomization in these 2 different THA studies and the authors did not carry out an intention-to-treat analysis, the findings may not fully reflect the effects of the assigned intervention in real clinical practice and could be subject to attrition bias favouring cryotherapy.⁴⁸

The authors of the CMC study³⁹ also reported limitations related to study quality, including lack of randomization, allocation concealment, selection bias, and lack of masking, with the overall certainty of evidence ranging from very low to moderate.

Furthermore, none of the included studies in this rapid review discussed minimally important difference values for any of the reported outcomes.⁴⁹ As a result, it remains unclear whether the observed differences are meaningful for patients, clinicians, or policy-makers in Canada.

Generalizability to the Health Care Context in Canada

The general applicability of the cryotherapy evidence for nonknee arthroplasty to clinical practice in Canada is uncertain given the limited and heterogeneous evidence base found. The evidence included in this rapid review is heterogeneous for study designs, populations, settings, cryotherapy protocols, standard of care comparator, and study analyses.

• Sample size and country setting: The authors of the included SR³⁸ analyzed data from 3 primary studies on THA conducted in 3 different countries, each with small sample sizes (n = 26 to 142 per study). Likewise, the nonrandomized study on CMC arthroplasty³⁹ is based on a small (n = 57), unpowered sample from a single country, and no study was conducted in Canada.

• Variation in cryotherapy devices: The studies identified for this Rapid Review report on 3 different cryotherapy devices (i.e., Icing System 2000, Game Ready System, NICE system). Although the Game Ready System and the NICE system have a Medical Devices Active Licence Listing (MDALL) from Health Canada, it is unclear whether the Icing System 2000 is available in Canada or has an MDALL approval. Although an MDALL indicates that these devices have met regulatory requirements in Canada for safety and intended use, the identified studies of clinical effectiveness did not provide strong signals for their use in patients after THA or CMC arthroplasty.

• Variation in cryotherapy protocols: The authors of the SR³⁸ reported that standardized protocols for cryotherapy were lacking, particularly with respect to cooling temperature, duration of treatment, and method or frequency of application. While the protocol for the Icing System 2000 and Game Ready systems were reported by the authors of the THA primary studies and the NICE system in the CMC study, it is unclear whether these protocols were partially or fully reported and used across Canada.

• Overall, these differences in cryotherapy interventions and lack of standardized treatment protocols may influence the magnitude and duration of the effects observed and preclude us from determining whether findings would be consistent across different cryotherapy approaches and clinical settings. The relatively small number of studies and participants limits the interpretations of the findings and might not be considered representative of broader postoperative populations, including patients receiving care in Canada.

Conclusions and Implications for Decision- or Policy-Making

This rapid review evaluated the literature regarding the clinical effectiveness of cryotherapy compared to standard of care for adult patients undergoing THA and carpometacarpal arthroplasty. We identified 1 SR³⁸ with 3 relevant THA primary studies^41-43 and 1 carpometacarpal nonrandomized clinical trial.³⁹

Summary of Evidence

In adult patients undergoing THA and CMC arthroplasty, the available evidence suggests that cryotherapy may provide short-term benefits for postoperative pain. Specifically, studies reported a reduction in patient-reported pain compared to the standard of care on postoperative days 1 and 2 for THA and up to 2 weeks in CMC patients, without increasing the risk of adverse events. Furthermore, intervention adherence was significantly higher in the cryotherapy group than in the standard of care in the CMC study,³⁹ and cryotherapy users also reported more frequent daily use compared to patients using standard of care. As allocation to the cryotherapy group was not randomized or masked in the CMC study, it is unclear whether adherence to the cryotherapy reflects real differences in usability, convenience, or the ability to maintain the prescribed treatment schedule compared to standard of care, versus other confounding factors. In addition, observed study benefits for pain and adherence did not appear to translate into significant improvements for other clinical outcomes, including analgesic consumption, blood loss, range of motion, or hospital length of stay. The evidence base for the clinical effectiveness of cryotherapy after THA and CMC arthroplasty is derived from few studies with several methodological limitations, thus reducing our confidence in the findings for these indications.

Reduction of postsurgical opioid use is an outcome of particular interest in Canada in the context of the ongoing opioid crisis. However, the evidence for this outcome after THA and CMC arthroplasty was limited in quality and quantity, and neither the identified SR nor the nonrandomized study reported statistically significant differences compared to the standard of care. The SR authors assessed the certainty of the evidence for analgesic use to be very low; this MA was based on findings from 2 high-risk-of-bias studies that conducted per-protocol analyses. In the CMC study,³⁹ the available outcome data for postsurgical oxycodone tablet intake was limited by study size and precision. This outcome showed a trend toward statistical significance in favour of the cryotherapy group. However, the study included only 57 patients (36 in the intervention group and 21 in the control group) and follow-up surveys were completed by 40 (70%) of study participants. This suggests a limited precision around the estimated effect.⁵⁰ As a result, the observed trend for lower oxycodone use in the cryotherapy group should be interpreted in the context of the small evidence base and potential confounders and should not be considered definitive evidence.

Considerations for Future Research

Future research in nonknee arthroplasty should prioritize several methodological aspects, including an adequately powered sample, multinational or multicentre RCTs, and robust statistical analysis (e.g., clearly defined per-protocol and intention-to-treat analysis), alongside transparent adherence and attrition reporting, to strengthen confidence in the estimated treatment effects. Studies should follow defined and reproducible cryotherapy protocols, including the type of device, cooling temperature, duration, frequency, and timing of treatment. Researchers should also consider evaluating the impact of cryotherapy when added to current multimodal analgesia recommendations and rehabilitation protocols. Potential outcomes to consider should include long-term follow-up for pain, analgesic consumption, functional recovery, range of motion, mobility, and adverse events.

Considerations for Clinical Practice

Decision-makers can use the summarized information in this rapid review to inform their decisions regarding the use of cryotherapy in patients undergoing THA and CMC arthroplasty in Canada. We did not identify evidence for cryotherapy for other nonknee joint arthroplasties (e.g., shoulder, elbow, wrist, or ankle) that met our inclusion criteria, precluding conclusions on its clinical effectiveness for these other indications.

Cryotherapy may be considered to alleviate acute postoperative pain, particularly during the first 2 postoperative days in patients who have undergone THA and for up to 2 weeks in patients who have undergone CMC arthroplasty. However, these findings should be interpreted cautiously given the limitations of the evidence base. Key limitations include the number of identified studies, underpowered sample sizes, overall study risk of bias, and unclear applicability of equipment and treatment protocols to clinical practice settings in Canada.

Considerations for implementing cryotherapy for patients in Canada after arthroplasty for joints other than the knee may include the uncertainty in the evidence base, safety, the impact on health care system resources (e.g., device costs), patient preferences, and appropriate monitoring for adverse effects.

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Appendix 1: Detailed Methods and Selection of Included Studies

Please note that this appendix has not been copy-edited.

What Is a Rapid Review?

Rapid Reviews are based on accelerated and abbreviated SR methods, balancing timeliness with rigour, to allow for timely decision-making.⁵¹ Due to these abbreviated methods, Rapid Reviews have some limitations. For example, we included studies published in English and from 2023, though the identified SR published in this time frame also included older studies. Our rapid review intends to summarize the available evidence, rather than provide recommendations. These findings should not be interpreted as prescriptive guidance.

Literature Search Methods

An information specialist conducted a literature search on key resources including MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the International HTA Database, the websites of health technology assessment agencies in Canada and major international HTA agencies, as well as a focused internet search. The search approach was customized to retrieve a limited set of results, balancing comprehensiveness with relevance. The search strategy comprised both controlled vocabulary, such as the US National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. Search concepts were developed based on the elements of the research questions and selection criteria. The main search concepts were cryotherapy and joint arthroplasty. Conference reviews, conference abstracts, and ClinicaTrials.gov records were excluded. The search was completed on August 11, 2026 and limited to English-language documents published since January 1, 2023.

Selection Criteria and Methods

One reviewer screened all records at the title and abstract screening stage. Potentially relevant articles and grey literature reports were retrieved for full-text review. The final selection of full-text articles was based on the inclusion criteria presented in Table 1.

Exclusion Criteria

Articles were excluded if they:

• did not meet the selection criteria outlined in Table 1

• were duplicate publications or were published before 2023

• were limited to TKA

• were published in languages other than English (for feasibility reasons).

Critical Appraisal of Individual Studies

The included publications were critically appraised by 1 reviewer using the following tools as a guide: A critical appraisal tool for SRs (AMSTAR 2)³⁶ and the Downs and Black appraisal tool.³⁷

Data Extraction

One reviewer extracted data directly into standardized tables created in Microsoft Word, which were modified as necessary. The extracted information included study characteristics, methodology (e.g., study design), population, intervention, comparator, and results regarding the outcomes of interest. Data such as demographics, device brand, cryotherapy protocols, and funding was extracted from primary studies. One THA primary study was in German language and data abstraction was not done from this primary study.

One reviewer extracted information from the included studies using the PROGRESS-Plus⁴⁴ tool to describe different population groups. Each included study was checked to determine if PROGRESS-Plus criteria were reported by study authors to describe the participants; detailed characteristics, if available, were then extracted and reported in tables in Appendix 3. The main PROGRESS-Plus⁴ criteria include place of residence; race, ethnicity, culture, and/or language; occupation; gender and/or sex; religion; education; socioeconomic status; and social capital. As part of report writing, we discuss these characteristics across the evidence, if available, when presenting results within the text.

When reporting on sex, gender, race, or ethnicity in this rapid review, we planned to retain the language used by the original study authors, and, whenever possible, we referred to these groups based on guidance from Canada’s Drug Agency Style: A Guide for Authors and Editors⁵² at the time this rapid review was conducted, with an understanding that language is constantly evolving.

As part of data extraction, for each included study, we screened the devices used for cryotherapy against the Medical Devices Active Licence Listing for licensed medical devices in Canada. This was to discern which devices were approved for use by Health Canada and to inform a discussion of the applicability of study findings to the clinical practice context in Canada.

Appendix 2: Selection of Included Studies

Figure 1: Selection of Included Studies — PRISMA⁴⁰ Flow Chart of Selected Reports

PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Note: This figure is a modified version of the original PRISMA 2020 flow diagram.

Appendix 3: Characteristics of the Included Publications

Please note that this appendix has not been copy-edited.

Table 2: Characteristics of the Included Systematic Review

NR = not reported; THA = Total Hip Arthroplasty; TKA = Total Knee Arthroplasty; ROM = Range of Motion.

ª= Of the 3 primary studies that informed this, 1 study was in German language, and data abstraction was not possible

^b= Approved by Health Canada

Table 3: Characteristics of the Included Primary Clinical Study

CMC = carpometacarpal.

ªApproved by Health Canada

Appendix 4: Critical Appraisal of Included Publications

Please note that this appendix has not been copy-edited.

Table 4: Clinical Effectiveness of Cryotherapy in Joint Arthroplasty of the Xie et al. (2026) Study:³⁸ — Strengths and Limitations of Systematic Reviews and Network Meta-Analyses Using AMSTAR 2³⁶

PICO = patient, population, or problem, intervention, comparison or control, outcome; RCT = randomized clinical trial; RoB = risk of bias

Table 5: Risk of Bias Assessment of the Zeng et al. (2026) Study³⁹ — Downs and Black Critical Appraisal Tool³⁷

Appendix 5: Main Study Findings

Please note that this appendix has not been copy-edited.

Table 6: Summary of Findings by Outcome From the Xie et al. Study (2026)³⁸ — Following Total Hip Arthroplasty

ROM = range of motion-degrees of flexion, POD = postoperative day, SD = standard deviation, mL = millilitres

^aVisual Analogue Scale

^bPrimary studies contributing to this pooled analysis evaluated total dose (mg) of oramorph, diclofenac sodium, and mepivacaine hydrochloride up to 72 hours postsurgery.

Table 7: Summary of Findings by Outcome From the Zeng et al. Study (2026)³⁹ — Following Carpometacarpal Arthroplasty

SANE = single assessment numeric evaluation; CTD = cryotherapy device

^aSelf-reported rating of the extremity as a “percentage of normal” from 0 to 100; higher SANE scores indicate better hand performance.