The When and How of Exercise after Total Knee Replacement

Do patients get better faster with an exercise program after a total knee replacement (TKR)? When should the rehab program be done? Two months after the operation? Four months later? Physical therapy researchers from Canada teamed up to answer these questions in this report.

Seventy-seven TKR patients were divided into two groups. All patients had their first TKR for knee osteoarthritis. Group one was the intensive functional rehabilitation (IFR) group. They had 12 rehab sessions with a physical therapist (PT) along with a home program of exercises. Group two had standard care with just the home program. Both groups were treated between months two and four after the TKR.

Everyone was tested for pain and function right after the TKR, right after the treatment, and eight months later. The six-minute walk test was used, which measures the distance walked in six minutes. Patients can use a walker, cane, or other helping device. They can stop and rest whenever needed.

The authors report that the IFR group walked farther than the control group each time they were tested after treatment. The IFR group also had less pain and stiffness right after the IFR program and again two months later (four months after the TKR). Performing daily activities was also easier for the IFR group. Patients in the IFR group reported only positive changes in their quality of life right after the intense rehab ended.

The results of this study suggest that more intense rehab is needed two to four months after TKR. Waiting two months gets the patient past the first phase of pain, swelling, and stiffness. Intense therapy wouldn't be possible during the early recovery time. An IFR program at the right time promotes better function even up to eight months later.


Hélène Moffet, PT, PhD, et al. Effectiveness of Intensive Rehabilitation on Functional Ability and Quality of Life after First Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. April 2004. Vol. 85. No. 4. Pp. 546-556.


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