Bilateral prehabilitation combining blood flow restriction and high-load resistance training improves preoperative reserve and early recovery following total knee arthroplasty

Purpose Persistent deficits in muscle strength and physical function remain common after total knee arthroplasty (TKA). This study investigated whether a bilateral prehabilitation program combining low-load blood flow restriction (BFR) resistance training of the operative limb with conventional high-load resistance training of the contralateral limb improves preoperative muscular reserve and postoperative recovery. Methods In this prospective RCT, 19 patients scheduled for primary TKA completed a six-week bilateral prehabilitation program. Participants were randomized to either low-load resistance training with BFR (60% limb occlusion pressure) or a sham-BFR control intervention for the operative limb, while both groups performed conventional resistance training of the contralateral limb. Outcomes included lower-limb strength, functional performance (6-minute walk test [6MWT], chair-rising test [CRT]), pain (VAS), and KOOS assessed preoperatively and up to three months postoperatively. Results Compared with controls, the INT achieved greater preoperative improvements in leg press and extension strength and maintained superior strength at 6 weeks and 3 months postoperatively (p < 0.05). Functional performance was superior, with better CRT and 6MWT performance preoperatively and at 3 months. Additionally, INT showed significantly lower pain values and greater KOOS improvements in Symptoms and Quality of Life before and three months postoperatively in comparison to CON (p < 0.05). Despite higher perceived exertion during exercise sessions, no adverse events occurred. Conclusions Bilateral prehabilitation combining low-load BFR training of the operative limb with high-load resistance training of the contralateral limb enhanced preoperative muscular and functional reserve, attenuated postoperative decline, and improved early recovery following TKA. Clinical trial registration https://clinicaltrials.gov/study/NCT06964022 , identifier NCT06964022.