For decades, the postoperative pathway after total knee arthroplasty (TKA) has been pretty standard — patient leaves the hospital, attends a series of in-person physical therapy sessions, performs their home exercise program (sometimes…), and gradually regains motion, strength, and confidence in their shiny new knee.
But — accelerated by global shifts in healthcare delivery — another option has entered the arena: telerehabilitation.
Instead of driving to the physical therapy clinic two or three times a week, patients log into a video session, follow guided exercise programs through apps, or interact remotely with therapists monitoring their progress from afar. It’s convenient, scalable, and undeniably modern.
But, does it actually work?
A recent literature review attempts to answer that question by examining the entire body of evidence surrounding telerehabilitation after TKA. And while the answer isn’t quite the mic-drop moment some digital health advocates might hope for, the results are intriguing — and potentially practice-changing.
The Rise of the Remote Knee
Telerehabilitation is becoming a legitimate component of musculoskeletal care.
Several factors are telerehabilitation adoption:
- More global demand for joint arthroplasty
- Problems accessing physical therapy
- Rising healthcare costs
- More and more intelligent telemedicine platforms
Orthopedic surgeons are a skeptical crowd, however. When it comes to postoperative outcomes, convenience alone doesn’t cut it. The real question is whether remote therapy produces outcomes comparable to traditional, hands-on physical therapy.
To answer those questions, these Arthroplasty Journal reviewers pulled data from multiple databases which provided high-quality systematic reviews and meta-analyses of telerehabilitation after TKA.
The goal: determine whether telerehabilitation is an effective alternative to conventional face-to-face rehabilitation after total knee arthroplasty.
Conclusion: Telerehab Works…Sort Of
When the authors pooled the available evidence, telerehabilitation demonstrated a statistically significant effect compared with conventional rehabilitation.
The pooled standardized mean difference (SMD) was: MD = –0.06, 95% CI: –0.16 to 0.03
At first glance, that effect size looks tiny — and it is. But here’s the key point: telerehabilitation appears to perform at least as well as traditional therapy in most measured outcomes. It’s not inferior. By some metrics, it may actually offer modest advantages.
Range of Motion Outcomes
According to the review, telerehabilitation showed improvements in passive knee flexion compared with conventional therapy.
Effect size: SMD = 0.26, 95% CI: –0.06 to 0.58
While not a massive difference, the results suggest remote rehab can achieve comparable — and potentially slightly better — range of motion outcomes.
This finding challenges a long-standing assumption that hands-on therapy is required to optimize postoperative knee motion. With the right guidance and patient engagement, many patients can achieve similar gains from their living room.
Patient-Reported Outcomes Also Improved
Telerehabilitation also demonstrated favorable results in two widely used knee outcome scores: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). SMD = –0.40
Knee Injury and Osteoarthritis Outcome Score (KOOS) SMD = –0.57. This suggests moderate improvement compared with traditional therapy. Again, showing a favorable trend toward remote rehabilitation.
Taken together, these findings indicate that patients participating in telerehabilitation programs reported comparable — or slightly better — functional outcomes and symptom improvement.
That’s not nothing.
Heterogeneity
Importantly, the reviewers found high heterogeneity across studies. The studies included in the review varied significantly in terms of rehab protocols, technology platforms, frequency of therapy sessions, patient populations, and outcome measurements.
So, when the researchers say “telerehabilitation works,” they’re really talking about a wide range of digital rehab strategies lumped together under one umbrella. Which raises an important clinical question: What type of telerehabilitation actually works best? The current evidence doesn’t fully answer that.
The Adherence Advantage
One underappreciated advantage of telerehabilitation may be improved patient adherence. Traditional physical therapy has several logistical barriers, specifically: transportation, scheduling conflicts, missed appointments, and travel time.
Remote rehab eliminates many of those obstacles.
Patients can complete sessions at home, often on flexible schedules. Some platforms also include automated reminders, progress tracking, and gamification elements that encourage participation.
And as every orthopedic caregiver knows, the best rehab program is the one the patient actually follows.
Origin Study Title: Effectiveness of Telerehabilitation After Total Knee Arthroplasty: An Umbrella Review
Authors: Huiping Xu; Vivian W.Q. Lou; Zixin Guo; Ruiqing Di; Xinyu Zhang; Yanjin Liu