DefinePK

Abstract

Background: Total knee replacement (TKR) remains the definitive treatment for end-stage knee osteoarthritis, offering substantial pain relief and functional restoration. Despite its widespread success, up to 20% of patients experience suboptimal recovery, often due to inadequate rehabilitation strategies. While postoperative rehabilitation is widely practiced, recent attention has turned to prehabilitation—structured preoperative exercise programs—as a potential enhancer of post-surgical outcomes. However, the comparative efficacy of prehabilitation, postoperative therapy, and combined approaches requires further investigation.
Objective: To evaluate and compare the effects of pre-operative, post-operative, and combined rehabilitation strategies on functional and patient-reported outcomes following TKR.
Methods: A single-center randomized controlled trial was conducted over 6 months, including 30 participants (aged 45–75) undergoing primary unilateral TKR, allocated equally into three groups (n=10 each): Group A received 6 weeks of pre-operative rehabilitation; Group B underwent an 8-week structured post-operative program; and Group C followed both protocols. Interventions included progressive strength training, aerobic conditioning, neuromuscular re-education, and pain management. Functional mobility was measured using the Timed Up and Go (TUG) test, and quality of life was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 4 weeks, and 8 weeks post-surgery. Data were analyzed using non-parametric tests due to non-normal distribution.
Results: All groups showed statistically significant within-group improvements over time (p < 0.001). At 8 weeks, Group C (combined rehabilitation) reported the most favorable outcomes (TUG: 1.08 ± 0.29; WOMAC: 1.08 ± 0.29). Group B showed better early gains at 4 weeks (TUG: 2.75 ± 0.45; WOMAC: 2.75 ± 0.45), while Group A showed limited long-term benefit (WOMAC at 8 weeks: 3.67 ± 0.77). Kruskal-Wallis tests confirmed significant between-group differences in favor of combined rehabilitation (p < 0.001).
Conclusion: Combined pre- and post-operative rehabilitation provides the most effective functional recovery by 8 weeks post-TKR, surpassing either strategy alone. These findings support integrating structured, multi-phase rehabilitation protocols into standard TKR care to maximize mobility and quality of life.