Effectiveness of combined bed pedaling and accelerated rehabilitation versus accelerated rehabilitation alone after total knee replacement: a randomised controlled trial

Abstract Background Total knee replacement (TKR) is the gold standard treatment for end-stage osteoarthritis. Postoperative conventional rehabilitation has shown limited benefits. Accelerated rehabilitation focuses on early mobilization and improving postoperative outcomes. Pedaling based interventions in acute setup have also shown potential benefits in improving functional outcomes. Thus, this study aimed to compare the combined effect of bed pedaling and accelerated rehabilitation with accelerated rehabilitation alone on knee pain, range of motion, muscle strength, swelling and functional outcome following TKR. Methods A single-center, parallel-group randomized controlled trial enrolled 72 patients (age 45–70 years) undergoing primary unilateral TKR from March 2025 to March 2026. Participants were randomly assigned to experimental group ( n = 36) or control group ( n = 36) using block randomization with allocation concealment. The experimental group received bed pedaling (forward and backward rotations) and accelerated rehabilitation. The control group received only accelerated rehabilitation. Both groups received treatment from day 0. The assessor was blinded to the intervention provided. Primary outcomes were pain, knee range of motion, knee flexor and extensor muscle strength, and knee swelling. Secondary outcome was functional outcome measured using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome measures were assessed at postoperative day 3, day of discharge (postoperative day 5), and 1-month follow-up. Analysis was done using two factor repeated measure ANOVA. Results 34 participants completed the follow-up in control group and 33 in the experimental group. Significant group differences were observed for pain ( p < 0.001), knee flexion ROM ( p < 0.001), extension lag ( p = 0.032), extensor strength ( p = 0.046), knee swelling ( p = 0.004), and WOMAC scores ( p < 0.001). Flexor muscle strength improved similarly in both the groups ( p = 0.286). Conclusions Combined bed pedaling and accelerated rehabilitation provides additional benefits compared to accelerated rehabilitation alone in improving pain, ROM, extensor strength, and functional outcomes after TKR. Although swelling improved over time, its long-term reduction may not be solely attributable to bed pedaling. These findings support incorporating bed pedaling with accelerated rehabilitation in early postoperative period. Trial registration Clinical Trials Registry of India (CTRI/2025/03/082973). Registered on 20/03/2025.