J Knee Surg 2016; 29(03): 201-217
DOI: 10.1055/s-0036-1579670
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rehabilitative Guidelines after Total Knee Arthroplasty: A Review

Jaydev B. Mistry
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Randa D. K. Elmallah
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Anil Bhave
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Morad Chughtai
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Jeffrey Jai Cherian
2   Department of Orthopaedics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
Tanner McGinn
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
Steven F. Harwin
3   Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York
Michael A. Mont
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

13 October 2015

31 January 2016

Publication Date:
10 March 2016 (online)


Rehabilitation following total knee arthroplasty (TKA) continues to pose a challenge for both patients and providers. In addition, guidelines vary considerably between institutions, which often leave therapy regimens to the discretion of the provider. The lack of clear guidelines for rehabilitation may contribute to inadequate recovery of strength and range-of-motion, resulting in less optimal functional outcomes. Therefore, the aim of this review was to highlight and discuss a variety of post-TKA rehabilitative modalities currently available and to provide evidence regarding efficacy and practicality. Specifically, we assessed the role of and evidence for exercise therapy, aquatic therapy, balance training, continuous passive motion, cold therapy and compression, neuromuscular electrical stimulation, transcutaneous electrical nerve stimulation, and instrument-assisted soft-tissue therapy. Additionally, we proposed general recommendations for rehabilitation after TKA, and as we specifically described active and obese patients, we have included guidelines for these subsets as well. Our review examines the various rehabilitative modalities to offer suggestions for recovery of strength and range-of-motion after TKA, with a focus on the early incorporation of exercise therapy, balance training, aquatic therapy, cryopneumatic therapy, neuromuscular electrical stimulation, and transcutaneous electrical nerve stimulation. Dedication and commitment to rehabilitation may help patients attain and exceed their preoperative activity levels.

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