Limited evidence supports that selected patients might be referred to an intensive supervised exercise program during late stage post total knee arthroplasty (TKA) to improve physical function.

Rationale
One high quality study (Evgeniadis 2008) and one moderate quality study (Akbaba 2014) investigated supervised exercise programs started after hospital discharge compared to no exercise or minimal exercise during the first two months after surgery. Evgeniadis et al compared a group of patients post total knee arthroplasty who received a home exercise program of eight weeks (three times a week) that consisted of lower extremity strength training, to a group who did not receive supervised exercises. The exercise group had significantly better physical function and knee flexion and extension range of motion. Akbaba et al compared a group of patients with bilateral total knee arthroplasty who received a month of intensive supervised rehabilitation (two times a week for one hour) to a control group who received supervised rehabilitation once every 15 days. The intense supervised group had less pain and stiffness, and better balance and physical function than the control group. 

Two high quality studies (Liao 2013, Moffet 2004) and one moderate quality study (Valtonen 2010) investigated supervised intensive exercise programs started two or more months after surgery (late stage post total knee arthroplasty) compared to no or less exercise. Liao et al compared a group who performed functional exercise supplemented with balance training to a group who performed functional training only. The exercise programs lasted eight weeks and started two months post-surgery. The group who received a combination of functional and balance exercises had better patient reported and performance-based outcomes of physical function. Moffet et al compared a group who received intensive functional training during eight weeks to a standard care group who received minimal rehabilitative care.  Pain and emotional health was significantly better in the intensive functional training group at 4 and 6 months, but the effects were no longer significant at the 12 months’ time point.  Valtonen et al compared a group who performed a high-intensity progressive aquatic resistance training of six week duration that started at least four months after surgery to a control group who did not exercise. The outcomes of both groups were similar. 
  1. Akbaba,Y.A., Yeldan,I., Guney,N., Ozdincler,A.R. Intensive supervision of rehabilitation programme improves balance and functionality in the short term after bilateral total knee arthroplasty. Knee Surg Sports Traumatol.Arthrosc. 2014/7/20; 0: -
  2. Evgeniadis,G., Beneka,A., Malliou,P., Mavromoustakos,S., Godolias,G. Effects of pre- or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation 2008; 3: 161-169
  3. Liao,C.D., Liou,T.H., Huang,Y.Y., Huang,Y.C. Effects of balance training on functional outcome after total knee replacement in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2013/8; 8: 697-709
  4. Moffet,H., Collet,J.P., Shapiro,S.H., Paradis,G., Marquis,F., Roy,L. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial. Arch Phys Med Rehabil. 2004/4; 4: 546-556
  5. Valtonen,A., Poyhonen,T., Sipila,S., Heinonen,A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement. Arch Phys Med Rehabil. 2010/6; 6: 833-839