Home-Based vs. Conventional Rehabilitation Following Total Knee Arthroplasty

Objective: The aim of this meta-analysis was to investigate whether home-based physical therapy (HPT) is as safe and effective as the conventional inpatient/outpatient physical therapy (CPT) after total knee arthroplasty (TKA). Methods: Three databases (PubMed, Web of Science, and Cochrane) were systematically searched on 8 January 2024. Randomized controlled trials (RCTs) comparing HPT with CPT following TKA were included. The outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 6 min walking test, range of motion (ROM), 36-Item Short Form Survey (SF-36), and visual analogue scale (VAS) for pain, and were analyzed at short-term (≤12 weeks) and mid/long-term follow-ups (>12 weeks). Results: Twenty RCTs (3706 patients) were included. Both groups experienced significant improvements, but no differences emerged when comparing all analyzed outcomes. WOMAC improvement was 36.2 points with HPT (p < 0.0001) vs. 39.2 with CPT (p < 0.0001); KOOS increased by 24.8 points with HPT (p < 0.0001) vs. 25.2 points with CPT (p < 0.0001); OKS improved by 16.1 points with HPT (p < 0.0001) vs. 16.3 points with CPT (p < 0.0001); ROM improved by 6.3° with HPT (p = n.s.) vs. 7.7° with CPT (p = 0.029); SF-36 improved by 3.3 points with HPT (p = n.s) vs. 7.4 points with CPT (p = n.s.); and VAS pain decreased by 2.5 points with HPT (p < 0.0001) vs. 3.0 points with CPT (p < 0.0001). Conclusions: HPT is a valid option for the post-operative rehabilitation of patients undergoing TKA, leading to results similar to CPT. This questions the need for a more complex and expensive management of these patients, considering the additional HPT benefits of healthcare cost reductions, early patient discharge, and less in-person physical therapy sessions, with equal patient final satisfaction. While this review offers a comprehensive representation of numerous studies, the research underlines significant heterogeneity in the reported data, thereby diminishing the overall robustness of the analysis, and future studies are needed to confirm the study results.