Fast Track Versus Standard Rehabilitation Protocol After Total Knee Replacement

Abstract

Abdullah Osama Abdullah*, Maher Elkabalawy, Mahmoud Hafez and Shaimaa E. Salem

Background: Total knee replacement (TKR) is a widely performed procedure for individuals suffering from end-stage knee osteoarthritis. Two primary rehabilitation approaches are employed, Fast Track Rehabilitation Protocol (FTRP) and Standard Rehabilitation Protocol (SRP).

Objective: This study aimed to compare effects of FTRP versus SRP on gait spatiotemporal parameters, functional outcomes, and knee scoring systems in patients having total knee replacement.

Methods: This randomized controlled trial was conducted involving 60 patients undergoing primary unilateral TKR. Patients were randomized into either the Fast Track Rehabilitation Group (n=30) or the Standard Rehabilitation Group (n=30). Functional and gait outcomes were assessed using gait spatiotemporal parameters (velocity, cadence, stride length, step length, swing time, and stance time) measured via Kinovea software, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) as well as Knee Society Score (KSS) for objective functional assessment. Assessments were conducted preoperatively, at 3 months, 6 months, in addition to 12 months postoperatively.

Results: At three months, Fast Track group showed significantly greater stride length (p=0.000) and gait velocity (p=0.002) than Standard group. The Fast Track group demonstrated significantly lower WOMAC scores, indicating better function, at three and six months (p=0.008, p=0.000). Both groups exhibited progressive improvement in Knee Society Score (KSS) over time, with no significant differences among groups at any time point (p > 0.05). At twelve months, both groups showed similar improvements, confirming that SRP achieved comparable outcomes over time.

Conclusion: While both Fast Track and Standard Rehabilitation Protocols effectively improve gait, functional capacity, and knee function within twelve months post-TKR, Fast Track Rehabilitation provides earlier improvements in mobility, pain reduction, and gait efficiency within the first three to six months. However, by one year postoperatively, both approaches result in comparable functional outcomes, suggesting that rehabilitation strategies should be tailored based on individual patient needs, tolerance, and preferences.