FROM OPERATING ROOM TO REHABILITATION: EVIDENCE-BASED PHYSICAL THERAPY IN TOTAL KNEE REPLACEMENT: A NARRATIVE REVIEW

Background: Total knee replacement (TKR) is the gold standard intervention for advanced knee osteoarthritis, offering substantial pain relief and improved function. However, up to 20% of patients experience persistent postsurgical pain (PPP), which adversely affects recovery and quality of life. Physiotherapy plays a central role in rehabilitation, yet considerable heterogeneity in protocols, patient responses, and long-term outcomes has created uncertainty regarding the most effective strategies. Objective: This narrative review aims to synthesize recent evidence (2020–2025) on physiotherapy interventions following TKR, with a particular focus on managing PPP, highlighting effective modalities, challenges, and future directions. Main Discussion Points: Evidence supports a phase-based approach: early mobilization reduces complications and enhances range of motion; progressive strengthening and functional retraining restore independence; and adjunctive modalities such as neuromuscular electrical stimulation, aquatic therapy, and cryotherapy enhance recovery. Technology-based solutions, including telerehabilitation and wearable monitoring, demonstrate promise in improving adherence and accessibility. Psychological factors such as catastrophizing and depression also strongly influence outcomes but remain under-addressed in physiotherapy programs. Persistent challenges include protocol variability, underrepresentation of high-risk subgroups, limited long-term evidence, and barriers to patient adherence. Conclusion: Physiotherapy after TKR is indispensable in reducing PPP and optimizing functional outcomes. Future research should prioritize large-scale, long-term trials, incorporate cost-effectiveness analyses, and integrate digital and psychological support. A personalized, multidisciplinary rehabilitation framework represents the most promising pathway to achieving sustainable improvements in postoperative recovery.