Effectiveness of muscle strengthening in early postoperative total knee arthroplasty: systematic review with meta-analysis

Leite, Alany Gabrielli; Vicente, Beatriz Batista; Mantovani, Alessandra Madia; Cavina, Allysiê Priscilla de Souza

doi:10.1590/1809-2950/e24007924en

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

SYSTEMATIC REVIEW • Fisioter. Pesqui. 32 • 2025 • https://doi.org/10.1590/1809-2950/e24007924en linkcopy

Effectiveness of muscle strengthening in early postoperative total knee arthroplasty: systematic review with meta-analysis

Eficacia del fortalecimiento muscular en el posoperatorio tras artroplastia total de rodilla: revisión sistemática con metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Total Knee Arthroplasty (TKA) is a surgical intervention, in which the affected joint is replaced by a prosthesis. Physical therapy is essential in rehabilitation after TKA, which can decrease the length of hospital stay, reduce symptoms and improve knee function. This study aimed to analyze the effects of muscle strengthening on the functioning of individuals with TKA in the early postoperative period. Studies were retrieved from the Pubmed, PEDro, LILACS, EMBASE, CINAHL and Cochrane Library databases, using following terms and keywords: Arthroplasties, Knee Replacement, Physiotherapy, Exercise, Rehabilitation and Postoperative. All included studies were assessed for methodological quality, using the PEDro Scale. Only randomized controlled trials involving unicompartmental knee replacement in the early postoperative period were included in this review. All meta-analyses were conducted using the Review Manager - RevMane software described as standardized mean difference (SMD) with 95% confidence intervals (CI). Nine studies were chosen to review the full text. The main findings demonstrated that muscle strengthening, after comparison with other variables, was effective only for the variable muscle strength (two studies, n=155; MD=−1.39, 95% CI [−2.58, −0.19]; p=0,02; I²=96%) improving overall functioning. For the other analyses, however, no significant differences were observed. This study outcomes suggest muscle strengthening-when initiated in the early postoperative period-is better than the comparison conditions in knee functioning.

Keywords
Knee Arthroplasty; Exercise; Physical therapy; Postoperative; Rehabilitation

Author, year, country, study type	Participant characteristics	Experimental Group (EG)	Control Group (CG)	Outcomes	Timepoints analyzed	Results
Sano et al., 2018¹⁶ Japan, Prospective quasi-randomized clinical trial	N=75	Standard rehabilitation program + SST	Control training group (standard rehabilitation)	Mobility with TUG; Knee function (ROM, quadriceps and hamstring muscle strength) and VAS	Preoperative; Postoperative (1, 2, and 3 weeks)	At all timepoints, patients in the SST group showed significantly greater mobility, although knee function was similar in both groups
	75.0 ± 6.4 years	N=37	N=38
	81.1% female (EG)	3 weeks	3 weeks
	75.8 ± 5.8 years	5 times a week + 1 set of 5 repetitions for 3 minutes per day (SST)	5 times a week
	78.9% female (CG)		5 times a week
Roig-Casasús et al., 2018¹⁷⁾ Spain, Randomized clinical trial	N=37	Rehabilitation training and training with a dynamometric platform	Control group	General state of balance (Berg scale); TUG; FRT; Functional reach test; Romberg open and closed eyes test	Before and after training; Follow-up was 6 weeks after the intervention	Significant differences between groups in balance performance according to the Berg scale (p=0.03) and the FRT (p=0.04) with a CI=95%
	N=37	N=17	rehabilitation training
	73.4 ± 4.4 years	4 weeks	N=20
	73.4 ± 4.4 years	20 sessions	4 weeks
	67.66% female	SD: 60 min + 20 min of exercises on the dynamometric platform	20 sessions
	67.66% female		SD: 60 min.
Shabbir et al., 2017¹⁸⁾ Pakistan, Randomized clinical trial	N=64	Treatment group	Control group	Range of motion measured by goniometer; VAS	After 4 weeks	There was no significant difference in goniometry in the reduction of extensor lag. However, there was a substantial improvement in pain in the treatment group
	N=64	Functional home training	Strength training
	60 ± 10 years EG, 71 ± 12 CG	N=31	N=33
	60 ± 10 years EG, 71 ± 12 CG	N=31	Once a day, 5 days a week
Buhagiar et al., 2017¹⁹ Australia, Randomized clinical trial	N=165 randomized	Group 1	Observational group	Range of motion measured by goniometer; Knee flexion ROM; EuroQol 5-dimension self-report questionnaire (EQ-5D) visual analogue scale; Oxford knee score; 15 m walk test	After 10 weeks; After 26 weeks; After 52 weeks	There was no significant difference in the 6-minute walk test between the inpatient rehabilitation and either of the two home-based program groups, nor patient-reported pain and function, or quality of life
	66.9 ± 8.4 years	Hospital rehabilitation + home program	Observational group
	66.9 ± 8.4 years	N=81	Eligible individuals who preferred to receive the program at home were followed for 6 months after surgery
	68% female	10 days
	68% female	2 times a day
	+ N=87	SD: 1 to 1:30 of individual physical therapy + 1 to 1:30 of class-based exercises
	+ N=87	Group 2	N=87
	observation group	Home program only N=84	N=87
Liu et al., 2018²⁰ China, Clinical trial	N= 86	n= 43	43	WOMAC	Start of group; 1 week before; 3 months PO	There was no significant difference between groups at the timepoints analyzed
	72.1+-7.4 years	Educational: 2 sessions per week, 4 weeks + Intervention	Educational program	VAS
	57 women	15 min bicycle; 30 min muscle strength, stability, and function; 30 min daily, three sessions per week, for 6 weeks; 10 min walk	2 sessions per week, 4 weeks	KOOS
Piva et al., 2019²¹ United States, Blinded randomized clinical trial	N=240	Group 1	Control	Physical Function (WOMAC-PF; 6-minute walk test; 40 m gait speed test; Stair climb test; Single-leg balance test; Chair stand test; Sit-to-stand test)	After 3 months; After 6 months	Analysis between arms for the WOMAC-PF demonstrated no differences between physical therapy and community exercise, physical therapy and control, and community and control. Performance tests demonstrated better results in the physical therapy arm compared with the community and control arms, and the community arms compared with the control arm.
		In-clinic exercises
		N=96
		12 weeks
	70 ± 7 years	12 sessions	N=48
		SD: 60 min
		Sessions were twice a week in weeks 1 to 3, once a week in weeks 4 to 7, and then bimonthly
		Group 2
	61.7% female	Community exercises	No intervention
		N= 96
		3 months
		24 classes
		SD: 60 min
Kubota et al., 2022²²⁾ Japan, Non-randomized clinical trial	N=85, 74.4 ± 7.5 years CG, 73.8 ± 5.6 years EG	Early rehabilitation group	Control group	END; flexion and extension ROM; isokinetic quadriceps and hamstring strength; gait analysis	Before surgery; After 3 days; After 3 weeks; After 6 months; After 12 months	There was a significant improvement in knee extension after 3 days, 3 weeks, and 6 months in the EG, and a decrease in pain at 6 months and 12 months in the EG. There was no significant difference between the groups in the other measures.
		N=41	N=39
		40 min per day, starting four hours after surgery	40 min per day, starting 2 days after surgery
Lenssen et al., 2006²³⁾ Netherlands, Randomized clinical trial	N=43	Treatment group	Control group	Active and passive flexion and extension ROM measured by goniometer; Functional status by WOMAC and KSS	Before surgery (2 weeks); After 4 days; After 6 weeks; After 3 months	There was no difference between the experimental and control groups in range of motion. Twice-daily physical therapy sessions did not produce different results from daily physical therapy sessions
	N=43	N=21	N=22
	67 ± 7 years	2 times a day, totaling 40 minutes per day. Quadriceps strengthening exercises and active and passive knee mobilization	Once a day, totaling 20 minutes per day. Quadriceps strengthening exercises and active and passive knee mobilization
Hamilton et al., 2020²⁴⁾ England, Randomized clinical trial	N=334	Group 1: Outpatient rehabilitation	Group 2: Home Rehabilitation	Oxford knee score for function; VAS; Likert scale for satisfaction; TUG for mobility.	6 weeks after surgery; After 8 weeks; After 14 weeks.	There was no significant difference in the improvement in mobility and functionality between the two groups. Overall satisfaction did not differ between the groups. However, greater satisfaction was reported in the EG with pain relief, ability to perform daily functional tasks, and ability to perform heavy functional tasks.
	N=334	N=163	N=171
	66.8 ± 9.46 years	18 sessions over 6 weeks.	18 self-directed sessions over 6 weeks.
	66.8 ± 9.46 years	Exercises based on a treatment protocol with range of motion, strengthening, proprioception, and gait.	Exercises based on unloaded knee flexion to promote range of motion and use of the weight of the limb to strengthen the quadriceps muscle

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Universidade de São Paulo Rua Ovídio Pires de Campos, 225 2° andar. , 05403-010 São Paulo SP / Brasil, Tel: 55 11 2661-7703, Fax 55 11 3743-7462 - São Paulo - SP - Brazil
E-mail: revfisio@usp.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[TFN1] SD: session duration; EG: experimental group; CG: control group; Min: minutes; SST: seated side tapping training; TUG: timed up and go test; ROM: range of motion; FRT: functional range test; WOMAC-PF: Western Ontario and McMaster Universities Osteoarthritis-Physical Function Index; VAS: pain visual analogue scale; KOOS: knee injury and osteoarthritis outcome score; NRS: pain numerical rating scale; KSS: Knee Society Score.