Early Physiotherapy for Post-Total Knee Arthroplasty Recovery: A Systematic Review of Randomized Controlled Trials on Quality of Life, Pain, and Range of Motion Outcomes.

BACKGROUND

Total knee arthroplasty (TKA) is a common procedure for managing advanced knee osteoarthritis, offering pain relief and functional restoration. However, post-operative rehabilitation is critical to optimise recovery. Early physiotherapy has been proposed to enhance range of motion (ROM), reduce pain, and improve quality of life (QoL), though its effectiveness remains debated.

OBJECTIVE

This systematic review evaluates the impact of early physiotherapy on pain, ROM, and QoL in post-TKA patients using evidence from randomized controlled trials (RCTs).

METHODS

A comprehensive literature search was conducted using PubMed and EBSCOhost for RCTs published in the past 10 years, following PRISMA guidelines. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Nineteen RCTs were selected, covering rehabilitation protocols including conventional physical therapy, range of motion exercises, isotonic strengthening exercises, patellar resurfacing, acupoint quadriceps massage, standard manual therapy, continuous passive movement, neuromuscular electrical stimulation, and supervised outpatient rehabilitation.

RESULTS

The analysis demonstrated that early physiotherapy significantly improves pain relief, ROM, and overall QoL in post-total knee replacement patients. Several interventions, particularly strengthening programs and early mobilisation, showed statistically significant improvements in clinical outcomes. While some studies had unclear or high risk of bias, the overall risk across the studies was assessed to be low, supporting the reliability of findings.

CONCLUSION

Evidence from RCTs supports the incorporation of early physiotherapy into post-TKA rehabilitation protocols to improve clinical outcomes. Future high-quality trials and standardized guidelines are needed to further refine rehabilitation approaches and promote adherence among patients.