Our review aims to evaluate the effectiveness of rehabilitation techniques ≤ 6 months post total knee arthroplasty (TKA) and their effects on pain, range of motion, and quality of life
A comprehensive systematic review and meta-analysis, aligned with the PRISMA 2020 checklist, was conducted to assess the impact of rehabilitation following total knee arthroplasty (TKA) for primary osteoarthritis. We performed an extensive search across MEDLINE (PUBMED), EBSCOhost, CINAHL, and EMBASE, using both MesH and keywords. Eligible full-text Randomized Clinical/Control Trial, focusing primarily on middle-aged and older patients aged 50-80 years who underwent TKA and received rehabilitation within 6 months post-surgery, were screened. The Cochrane Risk of Bias Tool and JADAD Score were used to evaluate study quality. The meta-analysis was further conducted to give insightful findings on the overall effectiveness and heterogeneity I2 of rehabilitation strategies post-TKA
Nineteen studies meeting the inclusion criteria were incorporated, encompassing a total of 2,073 patients who had undergone total knee arthroplasty (TKA). The risk of Bias was assessed using Cochrane Risk of Bias Tool, with fourteen classified as having low risk of bias eight as having unclear risk of bias and one as having high risk of bias.
Meta-Analysis was performed on several outcome measures. For pain, as assessed by KOOS and VAS as subgroups, there is no statistically significant difference between the experimental and control group (KOOS: SMD = 0.45, 95% CI [-0.41, 1.30], P = 0.31; VAS: SMD = -0.35, 95% CI [-1.11, 0.40], P = 0.36). Both subgroups indicated substantial heterogeneity (KOOS: I2 = 96%, P 0.00001; VAS: I2 = 90%, p 0.0001). In contrast, WOMAC subgroup revealed a small yet statistically significant difference favouring the experimental group (SMD = -0.25, 95% CI [-0.48,-0.02], P = 0.03), with no heterogeneity observed (I2 = 0%, P = 0.78). However the overall effect for pain was not statistically significant (SMD = 0.08, 95% CI [-0.47, 0.56], P = 0.76).
For range of motion, meta-analysis also found no statistically significant difference between the experimental and control groups (SMD = -0.38, 95% CI [-2.23, 1.57], P = 0.70). Heterogeneity across the studies was substantial (I2 = 97%, P 0.00001), indicating high variability. Similarly, quality of life showed no statistically significant difference between groups (SMD = 0.12, 95% CI [-0.58, 0.82], P = 0.73) with substantial heterogeneity (I2 = 97%, P 0.00001), again suggesting high variability among the included studies
Rehabilitation strategies Post-TKA surgery can effectively reduce pain, increase ROM, and improve overall QoL. However, the current findings highlight variability and inconsistency. Future large-scale double-blinded clinical trials are needed.
The findings provide valuable insight for physiotherapists to ensure better patient care, holistic rehabilitation strategies, and physiotherapy education related to post-TKA recovery
osteoarthritis
rehabilitation
