Effect of Preoperative Physiotherapy (Pre-Rehabilitation) on Postoperative Functional Recovery in Patients Undergoing Total Knee Replacement: A Randomized Controlled Trial

Background: Total Knee Replacement (TKR) is a common surgical procedure performed to relieve pain and restore function in patients with advanced knee osteoarthritis. Despite surgical advancements, postoperative functional limitations such as reduced quadriceps strength, pain, stiffness, and delayed mobility remain significant concerns. Preoperative physiotherapy (rehabilitation) has been proposed as an effective strategy to enhance postoperative outcomes by optimizing muscle strength, joint mobility, and functional performance before surgery. Objective: To evaluate the effectiveness of a six-week structured preoperative physiotherapy (pre rehabilitation) program on postoperative functional recovery in patients undergoing Total Knee Replacement. Methods: A randomized controlled trial was conducted on 80 patients diagnosed with advanced knee osteoarthritis and scheduled for unilateral Total Knee Replacement. Participants were randomly allocated into: a) Pre rehabilitation Group (n = 40) ? Received structured physiotherapy for 6 weeks prior to surgery along with standard postoperative rehabilitation b) Control Group (n = 40) - Received standard postoperative rehabilitation only. Outcome measures included: Visual Analogue Scale (VAS) for pain a) Knee Range of Motion (ROM) b) Quadriceps Muscle Strength (MMT) c) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Assessments were conducted preoperatively and at 6 weeks postoperatively. Statistical analysis was performed using paired and independent t-tests with significance set at p < 0.05. Results: The pre rehabilitation group demonstrated significantly better postoperative outcomes compared to the control group. * WOMAC scores improved by 48% in the pre rehabilitation group a) Quadriceps strength improved significantly (p < 0.001) b) Knee flexion ROM increased by 22% c) Postoperative pain levels were significantly lower. Effect sizes ranged from 0.9 to 1.6 (large effect). Conclusion: Preoperative physiotherapy significantly enhances postoperative functional recovery following Total Knee Replacement. Incorporating structured pre rehabilitation programs into routine surgical protocols may accelerate recovery, reduce pain, and improve functional independence.