Aftab Saman, Ali Hafiza Nida, Saeed Bushra, Sarwar Samaika, Dawood Muhammad Hamza, Pervez Maira
Ziauddin College of Physical Therapy, Karachi, Pakistan.
United College of Physical Therapy, Karachi, Pakistan.
Musculoskeletal Care. 2025 Sep;23(3):e70158. doi: 10.1002/msc.70158.
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.
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).
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.
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.
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.
全膝关节置换术（TKA）是治疗晚期膝关节骨关节炎的常见手术，可缓解疼痛并恢复功能。然而，术后康复对于优化恢复至关重要。尽管早期物理治疗的有效性仍存在争议，但已有人提出早期物理治疗可增加关节活动范围（ROM）、减轻疼痛并改善生活质量（QoL）。
本系统评价利用随机对照试验（RCT）的证据，评估早期物理治疗对全膝关节置换术后患者疼痛、ROM和QoL的影响。
按照PRISMA指南，使用PubMed和EBSCOhost对过去10年发表的RCT进行全面文献检索。使用Cochrane偏倚风险工具评估纳入研究的方法学质量。选择了19项RCT，涵盖的康复方案包括传统物理治疗、关节活动范围练习、等张强化练习、髌骨表面置换、穴位股四头肌按摩、标准手法治疗、持续被动运动、神经肌肉电刺激和门诊监督康复。
分析表明，早期物理治疗可显著改善全膝关节置换术后患者的疼痛缓解、ROM和总体QoL。几种干预措施，特别是强化方案和早期活动，在临床结果方面显示出统计学上的显著改善。虽然一些研究的偏倚风险不明确或较高，但评估的所有研究的总体风险较低，支持研究结果的可靠性。
RCT的证据支持将早期物理治疗纳入全膝关节置换术后康复方案，以改善临床结果。未来需要高质量的试验和标准化指南，以进一步完善康复方法并促进患者的依从性。
