Active physiotherapy after total knee arthroplasty in the course of degenerative disease: review of the literature

Total knee arthroplasty (TKA) is one of the most common procedures for advanced knee osteoarthritis. Despite surgical progress, many patients report persistent pain, functional deficits, and reduced quality of life. Physiotherapy remains central to recovery, yet the most effective rehabilitation strategies are still debated. A systematic review was conducted in PubMed, Scopus, and Web of Science. Studies published between 2017 and 2025 were eligible if they evaluated active physiotherapy supervised by a physiotherapist after TKA. Only prospective clinical trials with subjective and objective outcomes were included. Exclusion criteria comprised non-physiotherapeutic interventions, passive modalities, single-gender samples, comorbid conditions, and pilot or retrospective studies. Nineteen studies met inclusion criteria. Interventions included eccentric and concentric resistance training, task-oriented exercise, motor imagery, kinesiotaping, telerehabilitation, feedback-supported programs, and adjunctive techniques such as blood flow restriction or foam rolling. Most showed beneficial effects on pain, range of motion, balance, muscle strength, and functional independence. However, protocol heterogeneity and limited follow-up precluded identification of a single optimal approach. Structured active exercise maintained over weeks to months provided the most consistent benefits. Active physiotherapy is essential for recovery after TKA. Programs should be individualized, progressive, and feasible for long-term use, with adjunctive strategies serving as complements rather than substitutes. Current evidence aligns with international recommendations highlighting exercise, education, and patientcentered care. Further high-quality research is needed to standardize protocols, evaluate long-term outcomes, and determine cost-effectiveness in clinical practice.