Original Scientific Articles

Quality of life after total knee arthroplasty: effects of a 21-day inpatient rehabilitation program on pain and functional recovery

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Abstract

Introduction: Effective rehabilitation is essential for recovery after total knee arthroplasty (TKA), yet the magnitude of benefit from intensive inpatient programs remains incompletely defined. This work aimed to evaluate the effects of a standardized 21-day inpatient rehabilitation program on pain, functional status, and health-related quality of life after TKA, and to assess differences according to sex, age, and timing of rehabilitation.

Methods: In this prospective observational study, 100 consecutive patients (67% women; mean age 68.9±5.4 years) undergoing primary TKA for end-stage osteoarthritis participated in a standardized 21-day inpatient rehabilitation program. Outcomes were assessed at admission and discharge using the Numeric Rating Scale (NRS), WOMAC index, and SF-36 questionnaire. Changes were analyzed using paired statistical tests with effect size estimation.

Results: All outcomes improved significantly with large effect sizes: NRS decreased from 3.7±2.1 to 1.5±1.4 (d=1.26), WOMAC from 26.9±6.5 to 17.7±6.0 (d=1.47), and SF-36 increased from 75.6±7.9 to 82.9±6.2 (d=1.03) (all p<0.001), indicating substantial magnitude of change. Women and patients ?70 years had worse baseline functional status (p<0.05). Time to rehabilitation (1-6 months) was not associated with outcomes.

Conclusions: A structured 21-day inpatient rehabilitation program was associated with substantial improvements with large effect sizes in pain, function, and quality of life after TKA. Baseline disparities supported the need for tailored rehabilitation strategies, while findings suggested that program intensity might be more relevant than timing within the early postoperative period. Causal inference was limited by the observational design.

Keywords: total knee arthroplasty, rehabilitation, physical therapy modalities, recovery of function, pain measurement, quality of life

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