Rehabilitation for Total Knee Arthroplasty: A Systematic Review

We sought to determine the comparative benefit and harm of rehabilitation interventions for patients who have undergone elective, unilateral TKA for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005 through May 3, 2021. We included randomized controlled trials and adequately-adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. The team assessed strength of evidence (SoE). Evidence from 53 studies RCTs suggests, various rehabilitation programs after TKA may lead to comparable improvements in pain, ranged of motion and activities of daily living. Rehabilitation in the acute phase may lead to increased strength but result in similar strength when delivered in the post-acute phase. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period following TKA; risk of harms among various post-acute rehabilitation programs appears comparable. All findings were of low SOE. Evaluation of rehabilitation after TKA needs a systematic overhaul to sufficiently guide future practice or research including the use of standardized intervention components and core outcomes.