Rehabilitation for primary unilateral or bilateral total knee replacement in Indian population – A comparison of supervised and unsupervised physical therapy
Sunil Rajan, Ankit Solanki, Munuswamy Gurupadham Rajesh DhanasekarAbstract
Background:
Postoperative rehabilitation after total knee replacement (TKR) is essential for functional recovery; however, the comparative effectiveness of supervised versus unsupervised physiotherapy remains unclear, particularly in Indian populations with a high comorbidity burden.
Objective:
To compare supervised and unsupervised physiotherapy following primary unilateral or bilateral TKR in Indian adults.
Materials and Methods:
This prospective comparative study included 158 patients (77 in the supervised group and 81 in the unsupervised group) at a tertiary care center. Both groups followed the same standardized progressive exercise protocol, beginning on postoperative day 1. The primary outcome was the Oxford Knee Score (OKS) at 1 year, and the secondary outcomes included knee range of motion (ROM) at multiple time points up to 12 months.
Results:
Baseline characteristics were well matched (mean age, 65 years; 68% female; body mass index, 28.5 kg/m
2
; 64% bilateral TKR). Both groups achieved substantial OKS improvements from baseline (supervised: −29.2 points; unsupervised: −28.9 points;
Conclusion:
Both supervised and unsupervised rehabilitation produced large, clinically meaningful functional gains after TKR. Supervised therapy conferred small long-term OKS advantages and transient early ROM benefits in this Indian cohort, supporting home-based rehabilitation as a viable default strategy, while reserving supervised care for higher-risk patients.