Objective:

To compare the effects of different early exercise interventions initiated within 3 days post-total knee arthroplasty (TKA) on pain, joint function, and range of motion, and to rank their efficacy.

Approach:

• Study Design: A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) published in the past 10 years.
• Data Sources: Literature was searched in PubMed, Embase, Cochrane Library, Web of Science, and Scopus.
• Data Extraction: Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias Tool (RoB2).
• Statistical Analysis: A frequentist random-effects NMA was performed using Stata 18.0, with interventions ranked using surface under the cumulative ranking curve (SUCRA) values.

Key Findings:

• Functional training and resistance training showed favorable effects on pain relief compared to control (SMD: -4.23 and -1.57; SUCRA: 100% and 85.8%, respectively).
• Functional training and intelligence-assisted training provided greater improvement in WOMAC-based functional status (SMD: -1.51 and -1.35; SUCRA: 85.5% and 78.7%, respectively).
• Intelligence-assisted training and resistance training had the highest ranking probabilities for ROM improvement (SMD: 2.21 and 1.91; SUCRA: 94.7% and 88.9%, respectively).
• The certainty of evidence was moderate for pain and low for WOMAC and ROM.

Interpretation:

Functional training, intelligence-assisted training, and resistance training are early exercise strategies after TKA, with functional training showing favorable effects on pain relief and functional improvement.

Limitations:

• The certainty of evidence for WOMAC and ROM outcomes was low.
• Variability in exercise modalities and protocols may affect generalizability.

Conclusion:

The selection and combination of early exercise interventions should be based on rehabilitation stage and goals.

Sources:

• Systematic Review Registration