Adherence to total knee arthroplasty guidelines in Saudi physiotherapists

Abstract Introduction Total knee arthroplasty (TKA) is a widely performed surgical procedure for managing advanced stages of knee osteoarthritis. Following clinical practice guidelines (CPGs) is essential to ensure optimal reha-bilitation outcomes. Objective To evaluate the level of knowledge and compliance with evidence-based practice guidelines and recommendations related to TKA among physiotherapists in Saudi Arabia. Methods An online cross-sectional survey was administered among licensed physiotherapists practicing in Saudi Arabia who had managed at least one patient undergoing TKA within the past two years. The questionnaire in-cluded demographic questions, two clinical vignettes (prehabilitation and acute postoperative rehabilitation), and statements assessing agreement with evidence-ba-sed recommendations (EBR). Adherence levels were ca-tegorized, and statistical associations with demographic variables were analyzed using chi-square and ANOVA tests. Results The study included 391 physiotherapists (mean age: 31.5 ± 6.1 years), with males comprising 78% of the sample. Only 2 and 3% of participants fully adhered to the EBR in the prehabilitation and post-operative vignettes, respectively. Adherence was signi-ficantly associated with gender, years of experience, workplace setting, educational level, specialty, and the number of TKA cases managed (p < 0.05). Knowledge gaps were also evident in consensus statements, with less than half agreeing on the use of standardized outcome measures and postoperative management proto-cols. Conclusion Adherence to TKA CPGs among Saudi physiotherapists is generally low. Experience, workplace setting, and professional background influence adherence. There is a need for targeted educational interven-tions and systemic support to improve evidence-based practice in TKA rehabilitation.