Effect of combined hip and knee exercises on rehabilitation after total knee arthroplasty: A prospective randomized trial

Abstract

Background: To explore the clinical effect of combined hip–knee joint exercise compared with traditional postoperative rehabilitation after total knee arthroplasty (TKA).Methods: In a prospective, single-blind randomized controlled trial, 60 female patients with osteoarthritis who underwent unilateral TKA were randomly divided into three groups: a resistive intervention group, a nonresistive intervention group and a control group. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) values, Forgotten Joint Score (FJS)-12 values, isokinetic muscle strength, and gait test results were measured and recorded preoperatively, two weeks postoperatively and three months postoperatively.Results: With the preoperative evaluation as baseline, the resistive hip–knee joint exercise group had lower functional scores and stronger quadriceps femoris and hip abductor muscles than the nonresistive group (p<0.05 for both). Both hip–knee exercise groups had stronger quadriceps femoris, hip abductor and hip rotator muscles than the control group (p<0.05). Two weeks postoperatively, both hip–knee strength training groups had lower functional scores than the control group (p<0.05) but stronger quadriceps femoris and external hip rotator muscles (p<0.05). Preoperative and 2-week postoperative gait analysis revealed that combined hip–knee strengthening could increase step length (p<0.05) and the ability to stand on the affected limb (p<0.05).Conclusion: A 12-week regimen of combined hip–knee exercises could improve the function of the affected limb after TKA, the movement patterns of the knee joint during gait, and the therapeutic effect of TKA and accelerate patients’ rehabilitation. The effect of combined hip–knee exercises positively correlated with increases in exercise load.