Total Knee Arthroplasty: Evidence-Based Update

Course overview

Total knee arthroplasty remains one of the most frequently performed and clinically impactful surgical procedures in orthopaedic medicine. With over 1 million procedures projected annually in the United States by the end of this decade and a patient population that is simultaneously growing younger and more active, the imperative for rehabilitation and perioperative healthcare professionals to remain current with the rapidly evolving evidence base has never been greater. The past several years have witnessed transformative changes across the entire TKA care continuum, from preoperative optimization and surgical technique to rehabilitation methodology and return-to-activity planning, fundamentally reshaping how interdisciplinary teams approach patient care. These changes have been driven by an unprecedented volume of high-quality research, including landmark randomized controlled trials, multicenter prospective cohort studies, and comprehensive systematic reviews that have challenged long-held assumptions about optimal perioperative management and rehabilitation. Enhanced Recovery After Surgery protocols, now endorsed as the gold standard by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, have moved beyond theoretical frameworks into measurable clinical implementation with demonstrated dose-response relationships between protocol adherence and patient outcomes. The ERAS approach fundamentally reframes the surgical episode as a continuum requiring coordinated optimization across preoperative, intraoperative, and postoperative phases rather than isolated management of each phase independently. Concurrently, surgical advances including robotic-assisted arthroplasty, evolving fixation methods, and alternative alignment strategies have introduced new considerations for rehabilitation professionals who must understand the surgical context that shapes postoperative recovery trajectories. The evidence for rehabilitation setting selection has matured substantially, with high-quality randomized trials and meta-analyses now demonstrating that home-based and telerehabilitation models yield outcomes comparable to inpatient and clinic-based programs for most patients, while validated risk stratification tools enable clinicians to identify those who require more intensive support. Perhaps most notable among recent advances has been the emergence of blood flow restriction training as an evidence-based adjunct in TKA rehabilitation. Systematic reviews and meta-analyses now support its safety and efficacy for achieving meaningful strength gains at substantially lower mechanical loads than conventional resistance training, with applications spanning from postoperative day one through late-phase rehabilitation. This modality directly addresses the critical therapeutic gap during the early postoperative period when patients are too weak or symptomatic for conventional resistance training intensities. Meanwhile, the roles of nursing, occupational therapy, and interprofessional collaboration have been increasingly scrutinized through rigorous research, with evidence now supporting both structured ERAS-based nursing protocols that reduce complications and length of stay, and selective rather than routine home health service utilization with attention to adequate dosing when services are prescribed. This advanced-level continuing education course synthesizes the most current evidence across seven content modules, drawing from clinical practice guidelines issued by the American Academy of Orthopaedic Surgeons, the American Physical Therapy Association, the ERAS Society, the American College of Rheumatology, the American Occupational Therapy Association, and the European Knee Associates. The course is designed for physical therapists, occupational therapists, nurses, and allied health professionals who participate in the perioperative and rehabilitative care of TKA patients.