Physical exercise after knee arthroplasty

Total knee arthroplasty (TKA) is the very best of treatments for end-stage knee osteoarthritis. Most patients report successful long-term outcomes and lower levels of pain after TKA, but recovery is variable and the majority of patients continue to demonstrate lower extremity muscle weakness and functional deficits in comparison to age-matched control subjects. Because of the possible positive influence of postoperative rehabilitation and the lack of established standards for prescribing exercise paradigms after TKA, the aim of this study was to systematically review randomized, controlled studies to determine the effectiveness of postoperative outpatient care on short- and long-term functional recovery. The authors identified 19 studies as highly relevant for the review and four categories of postoperative intervention were discussed: 1) strengthening exercises; 2) aquatic therapy; 3) balance training; and 4) clinical environment. Ideal outpatient physical therapy protocols should include: strengthening and intensive functional exercises given through land-based or aquatic programs, the intensity of which is increased based on patient progress. Because of the highly individualized characteristics of these types of exercises, outpatient physical therapy performed in a clinic under the supervision of a trained physical therapist could provide the best long-term outcomes after the surgery.

The review concluded that supervised or remotely supervised therapy may be effective at reducing some of the impairments following TKA, but several studies without direct oversight produced poor results. Most studies failed to accurately describe the “usual care” or control groups and information about the dose, frequency, intensity and duration of the rehabilitation protocols were not present in several studies.