全膝关节置换术后主动和被动锻炼促进关节功能恢复的前瞻性研究

目的 探讨全膝关节置换(TKA)术后持续被动活动和主动功能锻炼对患者关节功能康复效果的影响. 方法采用前瞻性研究方法,选取2007年2月至2008年6月行TKA的80例患者为研究对象,所有患者按入院序号应用随机数字表法分为持续被动活动组(CPM组)和主动功能锻炼组(AP组),每组40例.CPM组术后早期应用CPM机行康复治疗,AP组则在专业康复医师指导下进行主动功能锻炼.记录患者术后第3、6、9天时的VAS评分,术后第3、6、9天、出院及随访时的关节活动度,患者住院天数.采用美国膝关节外科学会的评分系统(KSS)对患者术前、术后3、6个月随访时的患膝关节功能进行评分. 结果术后第3天,CPM组、AP组的平均VAS评分分别为2.37、3.02分,差异有统计学意义(t=-2.52,P=0.03).术后第6、9天两组患者平均VAS评分差异均无统计学意义(P>0.05).术后3、6、9 d及出院时两组患者的关节活动度差异均无统计学意义(P>0.05).56例患者(CPM组30例,AP组26例)获得随访.术后3个月,CPM组、AP组患者的关节活动度为别为105.50°、112.96°,差异有统计学意义(P=0.04),但术后6个月时两组差异无统计学意义(P>0.05).术后3、6个月两组患者KSS评分差异均无统计学意义(P>0.05). 结论 TKA术后功能恢复应强调主动功能锻炼而非被动锻炼.不推荐常规应用CPM,但对痛觉过敏及无法进行主动功能锻炼的患者,仍应考虑CPM辅助治疗,以促进关节功能的恢复.     

全膝关节置换术后主动和被动锻炼促进关节功能恢复的前瞻性研究

目的 探讨全膝关节置换(TKA)术后持续被动活动和主动功能锻炼对患者关节功能康复效果的影响. 方法采用前瞻性研究方法,选取2007年2月至2008年6月行TKA的80例患者为研究对象,所有患者按入院序号应用随机数字表法分为持续被动活动组(CPM组)和主动功能锻炼组(AP组),每组40例.CPM组术后早期应用CPM机行康复治疗,AP组则在专业康复医师指导下进行主动功能锻炼.记录患者术后第3、6、9天时的VAS评分,术后第3、6、9天、出院及随访时的关节活动度,患者住院天数.采用美国膝关节外科学会的评分系统(KSS)对患者术前、术后3、6个月随访时的患膝关节功能进行评分. 结果术后第3天,CPM组、AP组的平均VAS评分分别为2.37、3.02分,差异有统计学意义(t=-2.52,P=0.03).术后第6、9天两组患者平均VAS评分差异均无统计学意义(P>0.05).术后3、6、9 d及出院时两组患者的关节活动度差异均无统计学意义(P>0.05).56例患者(CPM组30例,AP组26例)获得随访.术后3个月,CPM组、AP组患者的关节活动度为别为105.50°、112.96°,差异有统计学意义(P=0.04),但术后6个月时两组差异无统计学意义(P>0.05).术后3、6个月两组患者KSS评分差异均无统计学意义(P>0.05). 结论 TKA术后功能恢复应强调主动功能锻炼而非被动锻炼.不推荐常规应用CPM,但对痛觉过敏及无法进行主动功能锻炼的患者,仍应考虑CPM辅助治疗,以促进关节功能的恢复.     

运用微信对人工膝关节置换术患者行院外延续护理的效果

目的探讨运用微信对人工全膝关节置换术（total knee arthroplasty, TKA）患者行院外延续护理的效果。方法选择2014年1月至9月在我科行TKA的患者120例,根据出院时间编号分为研究组（60例）和对照组（60例）,对照组采用TKA常规出院指导和随访方式;研究组利用微信平台,针对患者的实际恢复情况对其实施个体化的健康教育。比较两组患者术后1、3、6个月的美国特种外科医院（Hospi?tal for Special Surgery, HSS）膝关节评分、膝关节活动度（range of motion, ROM）,术后6个月的并发症发生率及对康复训练的满意度。结果研究组术后不同时间点的膝关节HSS评分及ROM明显高于对照组,术后6个月的总体并发症发生率（6.67%）低于对照组（16.67%）,差异具有统计学意义（χ2=4.227,P=0.040）;康复训练满意度（98.33%）明显高于对照组（86.67%）,差异具有统计学意义（χ2=4.324,P=0.038）。结论运用微信对TKA患者行院外延续护理方便快捷,利于指导和沟通,能有效促进人工TKA患者功能的恢复,减少并发症发生率,提高患者对康复训练的满意度,值得推广。     

Relationship between length of stay and manipulation rate after total knee arthroplasty

We hypothesized that a pattern of decreasing postoperative length of stay (LOS) in the hospital could lead to an increased rate of manipulation after total knee arthroplasty (TKA). The decision to manipulate is based on the patient's ability to perform normal physical activities, which may in large part be dependent on adequate knee flexion (ie, range of motion [ROM]). Decreased exposure to physical therapy (as a result of decreased LOS) may be a contributing factor leading to impaired functional ROM in the 6-week postoperative period. We examined records from 745 patients (2 surgeons) who had a primary TKA from 1993 to 1996. At our institution, development and implementation of clinical pathways resulted in a significant decrease in the average LOS beginning in 1993. The average LOS in 1993 was 6.4 ± 1.8 days (mean ± SD) and progressively decreased to 4.4 ± 1.0 days in 1996 (P < .0001). The rate of manipulation (patients manipulated at 6 weeks/total number of patients receiving TKA) was 6.0% in 1993 and increased to 11.3% (P = .09) in 1994, 13.5% (P = .02) in 1995, and 12.0% (P = .05) in 1996. In the period 1993–1996, patients requiring manipulation consistently had a lower ROM at discharge from the hospital (69.0 ± 10°, n = 67, P < .0001) compared with patients not requiring manipulation (80.7 ± 10.6°, n = 542). The relatively low frequency and charge for manipulation may justify the decision to decrease patient exposure to physical therapy through reduction in LOS. As efforts to decrease LOS continue, however, we must aggressively manage patients and provide adequate exposure to inpatient and outpatient physical therapy to ensure optimal ROM results.     

高龄骨关节炎患者膝关节置换术后功能与变量因素相关性的病例对照研究

目的:探讨多个变量因素与术后膝关节功能HSS评分的相关性,实现对患者进行综合有效的预后判断。方法:回顾2008年3月至2010年8月应用膝关节置换术治疗72例HoldenⅣ级膝关节炎患者作为研究组,男30例,女42例;年龄60～86岁,平均(71.9±6.2)岁。关节镜下清理术治疗的22例HoldenⅣ级膝关节炎患者作为对照组,男10例,女12例;平均年龄(70.5±5.9)岁。观测术前及术后1、2周关节活动度和HSS评分,分析患者年龄、身高、体重、BMI、肌力等影响因素。评估方法主要采用HSS评分方法。结果:研究组HSS评分、ROM均提高。全膝关节置换术后2周HSS评分与术前膝关节活动度、术前HSS评分、术前膝关节疼痛、术后早期CPM应用呈正相关。全膝关节置换术后2周HSS评分与患者年龄、身高、体重、BMI、肌力等因素无显著相关。结论:患者术前膝关节活动度、HSS评分、术前疼痛、围手术期并发症以及术后CPM应用初始角度均可影响膝关节置换术疗效。     

Home continuous passive motion machine versus professional physical therapy following total knee replacement

A vigorous rehabilitation program following discharge from the hospital is necessary for patients having a total knee arthroplasty to maintain and improve range of motion and function. To compare the effectiveness of the continuous passive motion (CPM) machine as a home therapy program versus professional physical therapy, a prospective, comparative, randomized clinical study of 103 consecutive primary total knee arthroplasties in 80 patients (23 bilateral) was performed. The CPM group consisted of 37 patients (49 knees), and the physical therapy group consisted of 43 patients (54 knees). At 2 weeks, knee flexion was similar in the two groups, but a flexion contracture was noted in the CPM group (4.2°). This difference is felt by the authors to be clinically insignificant. At 6 months, there were no differences in knee scores, knee flexion, presence of flexion contracture, or extensor lag between the two groups. The cost for the CPM machine group was $10,582 ($286 per patient), and the cost for professional therapy was $23,994 ($558 per patient). We conclude that the CPM machine after the hospital discharge of patients having total knee replacement is an adequate rehabilitation alternative with lower cost and with no difference in results compared with professional therapy.     

Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients

A study of 86 patients undergoing total knee arthroplasty (TKA) was performed to evaluate the role of cold compression. The patients were treated with cold compression or epidural analgesia for 3 days after TKA. Pain was measured on a visual analog scale, and total consumption of analgesics was recorded. Range of movement (ROM) was recorded before TKA until 3 weeks postoperatively. Weight bearing, blood loss, and time in hospital were recorded. Visual analog scale scores and analgesic consumption were equal in both groups. Range of movement at discharge was 75° in the cold compression group vs 63° in the control group. By 3 weeks' follow-up, ROM was 99° vs 88°. Mean Hb values averaged 120 mmol/L in the cold compression group vs 109 mmol/L in the control group after surgery. Mean time in hospital of patients with cold compression averaged 4.8 days vs 6.2 days in the control group. The study shows that cold compression therapy improves the control of pain and might thus lead to improvement in ROM and shorter hospital stay.     

Beneficial effects of continuous passive motion after total condylar knee arthroplasty.

A randomised, controlled study of the use of postoperative continuous passive motion (CPM) and immobilisation regimen after total condylar knee arthroplasty was performed. CPM resulted in a significant increase in both the early and late range of knee flexion. This increase occurred in both rheumatoid and osteoarthritic patients. The improvement of 10 degrees at 12 months allowed additional important function to be attained. CPM resulted in significantly earlier discharge from hospital. It did not increase the clinical incidence of wound healing problems, nor did it significantly increase the postoperative fixed flexion deformity or the extension lag. CPM can be recommended as a safe and effective modality to achieve more rapid and more successful postoperative rehabilitation after knee arthroplasty.     

全膝关节置换术后早期功能康复

目的　探讨全膝关节置换术后进行早期功能康复的方法和时机。方法　２３ 例（３４ 膝） 骨水泥全膝关节置换术后患者按照预定的康复计划进行早期功能锻炼。术后６ ｈ 内即开始进行膝关节ＣＰＭ 锻炼,２４ ｈ 下地站立。术后引流血予以回输。结果　术后２ 周平均关节活动度达９０°,ＨＳＳ评分平均７１ 分。３ 例出现切口局部皮缘灶性坏死延期愈合,无其它并发症。结论　术后早期功能锻炼安全可行,可使关节功能早期恢复,并可有效预防并发症。     

Quadriceps strength and the time course of functional recovery after total knee arthroplasty

STUDY DESIGN: Prospective study with repeated measures. OBJECTIVES: The overall goal of this investigation was to describe the time course of recovery of impairments and function after total knee arthroplasty (TKA), as well as to provide direction for rehabilitation efforts. We hypothesized that quadriceps strength would be more strongly correlated with functional performance than knee flexion range of motion (ROM) or pain at all time periods studied before and after TKA. BACKGROUND: TKA is a very common surgery, but very little is known regarding the influence of impairments on functional limitations in this population. METHODS AND MEASURES: Forty subjects who underwent unilateral TKA followed by rehabilitation, including 6 weeks of outpatient physical therapy, were studied. Testing occurred at 5 time periods: preoperatively, and at 1, 2, 3, and 6 months after surgery. Test measures included quadriceps strength, knee ROM, timed up-and-go test, timed stair-climbing test, bodily pain, and general health and knee function questionnaires. RESULTS: Subjects experienced significant worsening of knee ROM, quadriceps strength, and performance on functional tests 1 month after surgery. Quadriceps strength went through the greatest decline of all the physical measures assessed and never matched the strength of the uninvolved limb. All measures underwent significant improvements following the 1-month test. Quadriceps strength was the most highly correlated measure associated with functional performance at all testing sessions. CONCLUSIONS: Functional measures underwent an expected decline early after TKA, but recovery was more rapid than anticipated and long-term outcomes were better than previously reported in the literature. The high correlation between quadriceps strength and functional performance suggests that improved postoperative quadriceps strengthening could be important to enhance the potential benefits of TKA.     

The influence of continuous passive motion on outcome in total knee arthroplasty

All primary condylar total knee replacement arthroplasties (TKAs) performed from 1977 to 1984 at the authors' institution were divided into two groups based on the use of continuous passive motion (CPM) in the immediate postoperative period. The control group consisted of 73 patients who were treated with 95 TKAs without postoperative CPM. The average age was 65.4 years. The study group consisted of 38 patients who had 51 TKAs in which CPM was used postoperatively. The mean patient age was 62.8 years. The most common diagnoses in both groups were osteoarthritis and rheumatoid arthritis. Range of motion (ROM) was recorded preoperatively, at discharge, at three months, one year, two years, and at the last follow-up visit. There were no statistically significant differences in the ROM between the two groups at any of these time periods. At two years, the mean flexion and extension in the study group were 99 degrees and -4 degrees, respectively, compared to 103 degrees and -5 degrees in the control group. The average hospital stay was 11.2 days in the study group, whereas it was 15.1 days in control group. In the control group, there was one superficial infection, no deep infections, and four pulmonary emboli compared with three superficial infections, two deep infections, and no pulmonary emboli in the study group. There was no difference in the transfusion requirements between the two groups. CPM is advocated by the authors to help achieve discharge ROM earlier, but the protocol has been changed to begin CPM on the second postoperative day to allow the wound to stabilize.     

The role of continuous passive motion following total knee arthroplasty

A retrospective study of 94 knees with postoperative continuous passive motion (CPM) therapy was compared with a control group of 116 knees with no postoperative CPM following kinematic condylar total knee arthroplasty (TKA) performed in 1983. The diagnoses were similar in both groups, with osteoarthritis in 167 knees, rheumatoid arthritis in 34 knees, osteonecrosis in four knees, traumatic arthritis in four knees, and psoriatic arthritis in one knee. Average flexion at hospital discharge was 87.7 degrees in the control group and 90.2 degrees in the CPM group (p less than 0.02). Seventy-four percent of the CPM group and 60% of the control group had achieved 90 degrees of flexion by the time of hospital discharge. The number of days to achieve 90 degrees averaged 10.3 in the control group and 7.7 in the CPM group (p less than 0.001). There was no significant difference in flexion at two or three months or at one year after operation between the two groups. Five knees in the control group and one in the CPM group required manipulation. The duration of hospitalization was not significantly different between the two groups. Hemoglobin levels, operative blood loss, and transfusion requirements were not significantly different. Patients with CPM following TKA achieve motion earlier than those without CPM, but ultimate motion and complications are not affected.     

Reduced length of stay and faster recovery after total knee arthroplasty without the use of tourniquet

IntroductionTotal knee arthroplasty (TKA) is commonly performed using tourniquet despite being associated with several recognised complications that may affect patient's post-operative recovery and early rehabilitation. In this study we investigate whether or not use of a tourniquet during TKA was associated with shorter length of stay, faster recovery and lesser complications.Methods29 patients, who underwent bilateral sequential TKA, had their first TKA under tourniquet and the second TKA 15 (11–32) months later without tourniquet.All operations were performed by the first author using the same technique and instrumentation with the same early rehabilitation protocol. All patients were followed prospectively for a minimum of 8 months.All patients had the following parameters measured which included surgical time, length of stay, post-operative pain using Visual analogue score (VAS), calf circumference, drop in haemoglobin, haematocrit level, oxford knee score (OKS), and range of motion (ROM).ResultsTKA performed without the use of tourniquet had significantly shorter Length of hospital stay (3.6 vs 4.4, P < 0.05), significantly less pain on day 2 (1 vs 2; P < 0.05) and significantly smaller increase in calf circumference on day 2 (1.2 cm vs 2.3 cm; P < 0.05). Postoperative calf circumference increase of less than 2 cm in TKA without tourniquet was associated with shorter length of stay when compared with increase of more than 2 cm in TKA with tourniquet 2.9 days (SD 0.6) versus 3.9 days (SD 0.8) P < 0.05.ROM and OKS were significantly better in TKA without tourniquet at 6 weeks but no difference at 8 months.ConclusionsTKA done without tourniquet was associated with shorter length of stay, lesser pain and swelling, in addition to improved range of motion in the early post-operative period     

Actual Knee Motion during Continuous Passive Motion Protocols is Less Than Expected

Investigations of the usefulness of continuous passive motion (CPM) after TKA have yielded mixed results, with evidence suggesting its efficacy is contingent on the presence of larger motion arcs. Surprisingly, the range of motion (ROM) the knee actually experiences while in a CPM machine has not been elucidated. In this study, the ability of a CPM apparatus to bring about a desired knee ROM was assessed with an electrogoniometer. The knee experienced only 68% to 76% of the programmed CPM arc, with the higher percentages generated by elevating the head of the patient’s bed. This disparity between true knee motion and CPM should be accounted for when designing CPM protocols for patients or investigations evaluating efficacy of CPM.     

Continuous passive motion after tenolysis in hand therapy patients: a retrospective study

Continuous passive motion (CPM) is a common adjunct to the postoperative therapy program. Use of CPM has been advocated for a variety of diagnoses in hand rehabilitation. This retrospective study compares two groups of patients who underwent digital tenolysis (and/or capsulectomy) and evaluates the use of CPM in their postoperative therapeutic management. Both groups had initial injuries of fractures, tendon lacerations, and/or crush injuries resulting in surgical intervention. After therapeutic rehabilitation, the patients failed to gain satisfactory active ROM and elected to proceed with a secondary surgical procedure. Fifteen patients (19 digits) who used CPM machines in addition to their home exercise program were compared to 21 patients (24 digits) who did not use CPM. Primary outcome comparisons for this study were change in total active motion (TAM) over time (preoperative to discharge from therapy), duration of therapy, and total number of therapy visits. There was no significant difference (F=1.16, p=0.29) in the change in TAM for patients using CPM (39.89 degrees ) compared to those not using CPM treatment (31.83 degrees ). Furthermore, CPM users were seen for significantly more therapy sessions than non-CPM users (25.7 therapy visits compared to 18.54 therapy visits). Rehabilitation lasted approximately the same amount of weeks for both groups (CPM users 10.21 weeks vs. non-CPM users 11.42 weeks).     

Use of continuous passive motion after total knee arthroplasty

Sixty primary total knee arthroplasties in 43 Chinese patients were included into a prospective study. Twenty-six patients who had unilateral knee arthroplasty were randomized to receive continuous passive motion (CPM) or immobilization in the first week. The 2 groups of patients were comparable in demographic data and preoperative knee range of motion (ROM). In 17 patients who had 1-stage sequential bilateral arthroplasties, one side had CPM and the other side was immobilized. The active knee ROM was assessed regularly until 1 year after the operation. For all patients, the early active knee ROM in the CPM group was significantly better than the immobilization group. There was no difference after 7 days, however. For patients who had 1-stage bilateral total knee arthroplasties, the active knee ROM was significantly better on the CPM side until day 28. After 4 weeks, there was no difference between the CPM group and the immobilization group. Immobilization after total knee arthroplasty does not preclude good ROM.     

术前活动度对人工全膝关节置换术后功能影响的观察

目的回顾性分析患者手术前的活动度对人工全膝关节置换(TKA)术后功能的影响。方法随访2000年1月—2003年12月在我科行TKA的患者65例(97膝),年龄64．8±9．9岁(35～85岁)。其中骨性关节炎55例(81膝),类风湿关节炎10例(16膝)。单膝置换33例,双膝同时置换32例。所有患者按术前膝关节活动度数(ROM)分成两组,≤90°(5°～90°)49膝,>90°(95°～140°)48膝。对两组患者进行疗效(最大屈膝度、活动度、KSS评分及功能评分)对比。所有患者均采用Scorpio后稳定型骨水泥固定的假体,均为初期置换,全部手术由同一组医师完成。术后3 d在同一康复师指导下行患肢CPM及主动功能锻炼至出院。结果平均随访时间29个月(10～44个月)。所有膝关节的活动度从术前的平均84．2°(5°～140°)提高到术后的平均101．6°(40°～140°) (P=0．000);而最大屈膝度数术前的平均103．5°(25°～140°)与术后的平均101．6°(40°～140°)无显著差异(P=0．439);KSS膝关节评分从术前平均19．5分(-24～62分)提高到术后平均78．8分(50～95分)(P=0．000)。所有患者的总满意度为93．8％(61／65)。两个分组比较,ROM≤90°的膝关节ROM及最大屈膝度术后均较术前有提高,而ROM>90°的膝关节平均最大屈膝度术后反而下降。没有翻修及深部感染。结论(1)在影响TKA术后膝关节功能的多种因素中,手术技术是关键因素。(2)在其他因素相同的情况下,术前膝关节的活动度对TKA术后的功能也有很大的影响,术前活动度大的膝关节比那些术前活动度小的膝关节术后能获得更好的功能。     

运动想象训练对全膝关节置换术患者干预效果的分析

目的系统评价运动想象训练(MIT)对全膝关节置换手术(TKA)患者的干预效果。 方法检索荷兰医学文摘数据库(EMBASE)、PubMed、Web of Science、Cochrane Library、卫生保健及护理学数据库(CINAHL)、中国生物医学文献数据库(CBM)、中国知网、万方、维普数据库,收集关于MIT对TKA患者干预效果的随机对照试验。筛选研究对象为采用MIT联合常规物理康复或只进行常规物理康复的TKA术后患者,结局指标涉及股四头肌肌力、膝关节活动范围(ROM)、疼痛视觉模拟评分(VAS)、计时起立－行走测试(TUG)。运用Cochrane协作工具对纳入研究的质量进行评估,采用Stata 16.0软件进行Meta分析。 结果共纳入8篇文献,264例患者。Meta分析结果显示：MIT组与对照组相比,能显著提升TKA患者股四头肌肌力[标准化均数差(SMD)＝0.67,95%置信区间(CI)(0.37,0.96),P<0.001]、膝关节ROM [SMD＝0.60,95%CI(0.06,1.15),P＝0.032],降低VAS评分[SMD＝－0.64,95%CI(－1.00,－0.28),P＝0.001],但对TUG的影响无统计学意义[SMD＝－0.59,95%CI(－1.21,0.03),P＝0.063]。亚组分析显示,在慢性康复期(术后≥2周),MIT能显著提升膝关节ROM[SMD＝1.65,95%CI(0.84,2.45),P<0.001],降低VAS评分[SMD＝－0.63,95%CI(－1.10,－0.16),P＝0.008],而在急性康复期(术后24 h)MIT对膝关节ROM与VAS的影响无统计学意义(P>0.05)。 结论当前证据表明,MIT联合常规物理康复能够显著提升TKA术后患者股四头肌力量、膝关节ROM,缓解疼痛。但MIT对膝关节ROM与疼痛的干预效果受康复阶段的影响。     

肥胖患者膝关节表面置换术后的早期康复

目的探讨肥胖患者初次膝关节置换术后早期康复的方法。方法自2009年1月至2012年6月共完成肥胖患者初次膝关节置换42例42膝,男8例,女34例;年龄60～78岁,平均65岁,身体质量指数（BMI）33—52,平均46。术后早期进行持续被动关节运动增加关节活动度（ROM）和进行股四头肌及胭绳肌肌力的强化训练,延长住院时间至术后14d。分别以术前2d、术后2d、1、2、4、8、12、24周作为观察点,使用VAS疼痛评分、WOMAC评分和ROM对膝关节功能及疼痛程度进行评价。结果术后VAS疼痛评分、WOMAC评分低于术前,术后ROM高于术前,差异均有统计学意义。所有指标在术后4周以后均有逐步改善,但差异没有统计学意义。结论肥胖患者膝关节置换术后早期行功能锻炼及适当延长住院时间可以提高膝关节功能。     

A Home-Based,Remote-Clinician-Controlled,Physical Therapy Device Leads to Superior Outcomes When Compared to Standard Physical Therapy for Rehabilitation After Total Knee Arthroplasty

BackgroundThe optimal postoperative rehabilitation regimen following total knee arthroplasty (TKA) is not clearly defined. The advent of telerehabilitation offers potential for increased patient convenience and decreased cost, while maintaining similar outcomes to traditional physical therapy (PT). Therefore, we evaluated a novel, home-based, clinician-controlled, multi-modal evaluation and therapy device with telerehabilitation functionality for TKA.MethodsA total of 135 consecutive TKA patients receiving standard therapy protocol (STP) were compared to 135 consecutive patients receiving a home-based clinician-controlled therapy system (HCTS). Outcomes were assessed at 2, 6, and 12 weeks, including visual analog scale (VAS) for pain, knee injury and osteoarthritis outcome score JR (KOOS JR), and knee range of motion (ROM) measured by the same certified physical therapists.ResultsPostoperative knee ROM was greater in the HCTS group at all time points throughout the study period (P < .001 at 2, 6, and 12 weeks). VAS and the KOOS JR functional scores were statistically better (P < .001) in the HCTS group at all time points and exceeded the threshold for minimal clinically important difference (MCID) for both VAS and KOOS JR. There were significantly fewer cases of arthrofibrosis requiring manipulation under anesthesia (MUA) in the HCTS group (1.48 versus 4.44%).ConclusionFollowing TKA, a novel, home-based, clinician-controlled, multi-modal therapy device was superior to standard PTduring the first 12 weeks postoperatively for ROM, KOOS JR, and VAS (with all scores exceeding the MCID) and had substantially fewer manipulations for arthrofibrosis.