Zahed Mohamed, Alesawy Alzahraa Faris, Zahed Ziad Samir, Samir Rahafat, Eleisawy Mahmoud
Orthopedics, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR.
Clinical Microbiology and Immunology, Faculty of Medicine, Benha University, Benha, EGY.
Cureus. 2025 Jul 22;17(7):e88501. doi: 10.7759/cureus.88501. eCollection 2025 Jul.
Osteoarthritis (OA) is a common degenerative joint disease causing cartilage damage, bone erosion, and chronic pain, often leading to disability. Total knee arthroplasty (TKA) is frequently performed to relieve OA symptoms. Conventional therapy training (CTT) is the standard intervention, whether preoperative or postoperative. We assume that intensive therapy training (ITT) may have higher effects in some aspects. The study aims to evaluate the impact of postoperative CTT versus ITT on various physical measures and questionnaires over different follow-up periods. Our systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, searching until June 2024. We assessed the risk of bias using the Cochrane Risk of Bias 2 (ROB 2) tool. Data were analyzed using Review Manager 5.4 (Cochrane Collaboration, London, UK), with mean differences (MD) and 95% confidence intervals (CI), and heterogeneity was assessed via P-value and I tests. The study consisted of 1087 patients. In the first month of follow-up, ITT did not significantly reduce pain on the visual analog scale (VAS) compared to CTT, with similar results at three and 12 months (overall MD = -0.38, 95% CI = -1.56 to 0.8, P = 0.53). For Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, ITT showed significant improvement within the first week and at one month (MD = -14.60 and MD = -3.11, respectively), but not at later follow-ups. In range of motion (ROM) flexion, ITT significantly improved outcomes in the first week (MD = 8.60, P = 0.001), but showed no significant differences at one and three months. No other outcomes showed any significant difference, and both results in ITT and CTT were similar. In TKA rehabilitation, ITT provides early benefits, particularly in improving ROM flexion and WOMAC scores during the initial postoperative week. However, ITT does not show significant advantages over CTT in terms of walking distance, quadriceps strength, ROM extension, or pain reduction throughout various follow-up periods. While ITT offers slight early gains, it does not present long-term benefits over CTT. Incorporating preoperative training into the postoperative regimen may be beneficial. We recommend that high-intensity exercises may not be necessary, as they yield similar results to conventional methods. However, further research is needed to explore both early and long-term outcomes that are not fully addressed in current studies.
骨关节炎（OA）是一种常见的退行性关节疾病，会导致软骨损伤、骨质侵蚀和慢性疼痛，常导致残疾。全膝关节置换术（TKA）常用于缓解OA症状。传统治疗训练（CTT）是标准干预措施，无论术前还是术后。我们假设强化治疗训练（ITT）在某些方面可能有更高的效果。本研究旨在评估术后CTT与ITT在不同随访期对各种身体指标和问卷调查的影响。我们的系统评价和荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）和Cochrane指南，检索至2024年6月。我们使用Cochrane偏倚风险2（ROB 2）工具评估偏倚风险。使用Review Manager 5.4（Cochrane协作网，英国伦敦）分析数据，计算平均差（MD）和95%置信区间（CI），并通过P值和I²检验评估异质性。该研究共纳入1087例患者。在随访的第一个月，与CTT相比，ITT在视觉模拟量表（VAS）上并未显著减轻疼痛，在3个月和12个月时结果相似（总体MD = -0.38，95%CI = -1.56至0.8，P = 0.53）。对于西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分，ITT在第一周和第一个月显示出显著改善（MD分别为-14.60和-3.11），但在后期随访中未显示改善。在活动范围（ROM）屈曲方面，ITT在第一周显著改善了结果（MD = 8.60，P = 0.001），但在1个月和3个月时无显著差异。没有其他结果显示出任何显著差异，ITT和CTT的结果相似。在TKA康复中，ITT能带来早期益处，尤其是在术后第一周改善ROM屈曲和WOMAC评分。然而，在整个随访期间ITT在步行距离、股四头肌力量、ROM伸展或减轻疼痛方面并未显示出比CTT有显著优势。虽然ITT能带来轻微的早期收益，但与CTT相比并没有长期益处。将术前训练纳入术后方案可能有益。我们建议高强度运动可能没有必要，因为它们与传统方法产生相似的结果。然而，需要进一步研究探索当前研究中未充分涉及的早期和长期结果。
