Convection-based vs conduction-based cooling in rehabilitation: A cadaveric porcine study of surface and intra-articular temperature reduction

doi:10.5493/wjem.124656

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World Journal of Experimental Medicine

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2220-315x

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Exp Med. Sep 20, 2026; 16(3): 124656
Published online Sep 20, 2026. doi: 10.5493/wjem.124656

Convection-based vs conduction-based cooling in rehabilitation: A cadaveric porcine study of surface and intra-articular temperature reduction

Mariam A Ibrahim, Bassant Abdelhameed, Amir Beltagi, Mohammad Masoud, Sara Abdel-Aal Mohamed, Ahmed A Khalifa

Mariam A Ibrahim, Bassant Abdelhameed, Orthopedic and Trauma Rehabilitation Unit, Orthopedic and Trauma Surgery Department, Assiut University Hospital, Asyut 71515, Egypt

Amir Beltagi, Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt

Mohammad Masoud, Department of Orthopaedics, Assiut University Hospital, Asyut 71515, Egypt

Sara Abdel-Aal Mohamed, Department of Parasitology, Assiut University, Asyut 71515, Egypt

Ahmed A Khalifa, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qina 83523, Egypt

Ahmed A Khalifa, Department of Orthopedic, Aster Sanad Hospital, Riyadh 13216, Saudi Arabia

Author contributions: Ibrahim MA and Abdelhameed B performed data analysis; Ibrahim MA conceived and designed the study, coordinated data collection, interpreted the findings, and drafted the manuscript; Abdelhameed B contributed to data entry and provided methodological support; Beltagi A assisted with study methodology, offered statistical guidance, and critically reviewed the manuscript; Masoud M provided clinical supervision, contributed surgical expertise, and assisted in interpreting clinical data; Mohamed SAA obtained the ethical committee approval, supported the statistical analysis, validated the data, and assisted with manuscript editing; Khalifa AA provided senior oversight, contributed to study conceptualization, assisted with interpreting results, and critically revised the final manuscript. All authors discussed the results and commented on the manuscript. All authors read and approved the final manuscript.

AI contribution statement: AI-assisted tools were used only in a limited supportive capacity during the preparation of this manuscript. Grammarly was used for language polishing, including grammar, clarity, formatting, and some paraphrasing. ChatGPT (OpenAI) was used to enhance the manuscript presentation and the visual quality of the figures, without altering, fabricating, or manipulating the underlying scientific data or results. No part of the manuscript's scientific content was independently generated by AI. AI tools were not used for study design, data generation, statistical analysis, interpretation of the results, or formulation of the scientific conclusions. No figures or images containing AI-generated scientific data were created. All AI-assisted modifications were critically reviewed and verified by the authors. The authors take full responsibility for the accuracy, originality, scientific integrity, and final content of the manuscript.

Institutional animal care and use committee statement: This study was reviewed and approved by the Ethical Committee of the Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt (approval No. 06/2025/0390).

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.

Data sharing statement: All the data related to the current study are mentioned within the manuscript.

Corresponding author: Ahmed A Khalifa, MD, MSc, Assistant Professor, FRCS, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qina 83523, Egypt. ahmed_adel0391@med.svu.edu.eg

Received: June 23, 2026
Revised: July 14, 2026
Accepted: July 30, 2026
Published online: September 20, 2026
Processing time: 91 Days and 15.2 Hours

Abstract

BACKGROUND

Postoperative inflammation after joint injury or surgery contributes to pain, edema, and delayed functional recovery. Cryotherapy is commonly used to alleviate pain and modulate inflammatory responses; however, the effectiveness of various cooling modalities in reducing temperatures in deeper periarticular and intra-articular tissues remains uncertain.

AIM

To compare the cooling performance of a convection-based cryotherapy system with two circulating-pad cooling systems in reducing temperature at various tissue depths.

METHODS

A cadaveric porcine knee model was used to assess comparative thermal transfer in periarticular tissues and the joint space. Thermocouples were placed at three sites: Subdermal, intramuscular, and intra-articular. Four experimental cooling conditions were evaluated by using: SootheAway 1 (SA1), SootheAway 2 (SA2), ThermoCuff (convection-based), and ambient control. Each cooling session lasted 60 minutes using a target coolant/air temperature of 35 °F (1.6 °C). The prespecified primary endpoint was the change in temperature at 20 minutes (ΔT20 = T20 - T0).

RESULTS

ThermoCuff produced a larger observed early temperature reduction through the tested compartments. At the subdermal level, ΔT20 was -14.8 °C with ThermoCuff compared with -8.4 °C for SA2, -3.9 °C for SA1, and -1.8 °C for ambient exposure. Intramuscular cooling was modest with ThermoCuff (-1.8 °C) and SA2 (-1.3 °C), whereas SA1 showed warming (+6.5 °C). At the intra-articular level, ThermoCuff achieved the highest temperature reduction (-10.0 °C), compared with -3.9 °C for SA2 and -3.3 °C for ambient exposure; SA1 showed warming (+4.8 °C).

CONCLUSION

In the cadaveric porcine knee model, the convection-based system achieved better early cooling than the circulating-pad systems, especially at the subdermal and intra-articular levels. These preliminary preclinical findings support the hypothesis that cooling modality might affect the depth and magnitude of thermal transfer under controlled laboratory conditions and require in vivo confirmation before clinical translation.

Keywords: Cryotherapy; Convection-based cooling; Conductive cooling; Intra-articular temperature; Cadaveric porcine model; Rehabilitation

Core Tip: Thermal transfer from various cryotherapy systems was evaluated using a cadaveric porcine knee model. Subdermal, intramuscular, and intra-articular temperatures were measured with thermocouples during cooling using ThermoCuff, two SootheAway circulating-pad systems, and an ambient control. The primary endpoint was the change in temperature at 20 minutes. ThermoCuff was relatively better in achieving early cooling, particularly in subdermal and intra-articular sites, with intra-articular temperature decreasing by about 10.0 °C. Intramuscular cooling was modest across all systems. These preliminary results indicate that convection-based cryotherapy may achieve apparently higher deep-tissue cooling than circulating-pad systems; however, in vivo validation is required before clinical application.