Table 1.
Characteristics of the included studies.
| Study | Baseline characteristics | Number of participants | Interventions | Outcome(s) | Strength training parameters | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| EG (mean, SD) | CG (mean, SD) | EG | CG | Duration (weeks): | Frequency (times per week): | Volume (minutes per session): | Initiated time (days after surgery): | |||
| Moffet 2004 |
Men/women: 14/24 Age: 66.7 (8.7) BMI: / |
Men/women: 17/22 Age: 68.7 (8.3) BMI: / |
EG: 38 CG: 39 |
Warm-up and stretching exercises Specific strengthening exercises: 1. Isometric for knee extensors: flex 0° 2. Isometric for knee extensors: flex 60° 3. Isometric for hamstrings: flex 60° 4. Concentric-eccentric for hip abductors Functional task-oriented exercises: 1. Getting up and sitting down 2. Knee extensor strengthening while standing with Theraband 3. Controlled bilateral knee flexion–extension while standing 4. Unilateral knee flexion to 90° while standing 5. Climbing on a platform or a flight of stairs 6. Walking backward on a slope and/or laterally while crossing lower limbs 7. Walking in place with a large amplitude of hip and knee flexion and upper-limb movements Endurance exercises Cool down |
Standard care: simple exercises to retrain lower-limb strength (quadriceps, hamstrings, hip abductors and extensors) and to increase knee mobility, as well as some advice about knee positioning, ice application, and gait retraining | 6MWT | 8 | 1.5 | 52.5 | 60 |
| Jakobsen (2014) Denmark |
Men/women: 14/21 Age: 66 (56–73) BMI: 29.8 (27.5–36.0) Presented as median (IQR) |
Men/women: 16/21 age: 63 (57–68) BMI: 29.4 (26.9–32.0) Presented as Median (IQR) |
EG: 35 CG: 37 |
CG + knee extension and leg press with increased loads and decreased repetitions for progression | Standard care: warm up, range of motion exercise, stretching exercise, functional training, balance training and icing | 6MWT | 7 | 2 | 42.5 | 2 |
| Vuorenmaa 2014 Finland |
Men/women: 23/30 Age: 69 (8) BMI: 31 (5) |
Men/women: 19/36 Age: 69 (9) BMI: 31 (6) |
EG: 53 CG: 55 |
Isometric strengthening exercises for the quadricep and hamstring muscles at multiple knee joint angles, rising on the toes, stepping up and down, squatting, and hack squatting exercises | Usual care: active and passive knee range of motion exercises, knee flexor and extensor exercises, hip abductor and extensor exercises in the standing position (using the weight of an extremity as resistance) and icing | TUG | 16 | 3 | 60 | 60 |
|
Bily 2016 Austria |
Men/women: 9/17 Age: 64.9 (6.0) BMI: 28.7 (4.1) |
Men/women: 9/20 Age: 68.3 (6.7) BMI: 28.0 (3.8) |
EG: 26 CG: 29 |
Strength training on a computer-controlled, linear motor-powered leg-press machine Training progressed from purely isokinetic to eccentric-concentric |
Ergometer cycling, manual therapy, and soft tissue techniques to improve scar and joint mobility, ROM-exercises, isometric and dynamic strengthening exercises, and gait-retraining exercises quadriceps setting, straight leg raise, seated knee extension, etc. without resistance |
TUG | 6 | 2 | 15 | 49 |
| Harikesavan 2017 India |
Men/women: 6/4 Age: 63.3 (5.4) BMI: 26.5 (3.2) |
Men/women: 4/6 Age: 62.8 (5.9) BMI: 29.8 (3.2) |
EG: 10 CG: 10 |
CG + hip abductor strengthening exercises abduction lying on side, unilateral hip abduction performed standing (from no resistance to ankle weights), isometric hip abductor strengthening exercise, calm exercises for hip abductors, standing wall isometric hip abduction, calm exercises with resistance with TheraBand, functional exercises, and walking |
Early mobilization, such as reducing pain and swelling, improving knee flexion and extension range of motion, and progressive quadriceps strengthening exercises to maximize function |
6MWT TUG |
12 | 2.5 | 42.5 | 8 |
| Jørgensen (2017) Denmark |
Men/women: 16/15 Age: 64.8 (8.3) BMI: 29.8 (4.8) |
Men/women: 10/14 Age: 64.4 (8.7) BMI: 28.4 (2.8) |
EG: 31 CG: 24 |
Warm-up, leg press and knee extension exercises in strength training machines (Technogym®, Cesena, Italy) (week 1) and knee flexion (added from week 3) Increased sets and loads for progression |
Home-based exercise programme focused mainly on blood and lymph circulation and knee range of movement | 6MWT | 8 | 2 | 30 | 3 |
| Husby (2018) Norway |
Men/women: 10/11 Age: 61 (46–72) BMI: 31 (5.3) Age presented as median (IQR) |
Men/women: 8/12 Age: 63 (45–73) BMI: 28.6 (5.1) Age presented as median (IQR) |
EG: 21 CG: 20 |
Warm-up: walking or ergometer cycling; maximal strength training: leg presses and knee extensions in the operated leg only; when participants were able to perform 6RM, the load was increased by 5 kg for leg presses and by 0.5–1 kg for knee extensions |
Standard rehabilitation: 2–3 physiotherapy sessions a week for 8 weeks, telephone contact by project leader once a week, writing training diary |
8 | 3 | 30 | 8 | |
| Schache 2019 |
Men/women: 15/39 Age: 70 (7) BMI: 30 (6) |
Men/women: 21/30 Age: 69 (7) BMI: 31 (6) |
EG: 54 CG: 51 |
Same usual care as CG additional hip strengthening exercises: hip abduction while lying on side, prone hip extension, sideways walking, standing hip abduction, and hip hitching |
Usual care: improve quadriceps strength, increase active knee flexion range of motion, improve hamstring strength, increase knee extension range of motion, and improve calf muscle strength and flexibility Additional usual care: sitting to standing, marching, and walking |
6MWT TUG |
11 | 6 | 60 | 12 |
| Do (2020) Korea |
Men/women: 3/16 (hip), 3/17 (quad) Age: 72.84 (7.03) (hip), 72.50 (4.73) (quad) BMI: 37.19 (2.59) (hip), 37.60 (3.03) (quad) |
Men/women: 3/13 Age: 73.13 (no SD reported) BMI: 37.62 (2.75) |
EG (hip): 20 EG (quad): 20 CG: 20 |
Hip: warm up, supine extension bridge with Theraband, sideway walking with Theraband, standing hip adduction with Theraband, hip external rotation with Theraband quadriceps: warm up, seated knee extension with Theraband, supine straight leg raise with theraband, quarter wall squat with Theraband |
Active range of motion exercises of the knees |
6MWT TUG |
12 | 3 | 30 | 180 |
| Huang FF 2020 China |
Men/women: 15/30 Age: 69.71 (4.15) BMI: 23.95 (2.87) |
Men/women: 17/28 Age: 69.62 (4.23) BMI: 23.79 (2.66) |
EG: 45 CG: 45 |
CG + knee extension-flexion exercises initiated immediately after surgery with sand packs weighted 1.0, 2.5, 3.5 or 4.5 kg on the ankle Massage was applied after training for muscle relaxation |
Non-resistance exercises on bed: straight leg raise, ankle pump, isotonic quadriceps contraction, and passive knee range of motion training; knee extension-flexion exercises against gravity initiated 1 week after surgery |
6MWT | 12 | 7 | 15 | 7 |
|
Liao CD (2020) Tai wan, China |
Age: 72.22 (7.75) BMI: 28.54 (3.88) Men/women: not reported |
Age: 69.79 (6.72) BMI: 27.25 (4.36) |
EG: 30 CG: 30 |
min warm-up, 40-min period of elastic resistance exercises, and a 10-min cool down Elastic resistance exercises: seated chest press, seated row, seated shoulder press, hip circumduction, leg press, and leg curl |
Standard care: education, pharmacologic therapy, active and passive range of motion exercise, stretching exercise, and functional reconditioning exercise | TUG | 12 | 2 | 60 | 30 |
| Trudelle 2020 USA |
Men/women: 0/6 Age: 61.8 (7.0) BMI: 33.0 (6.9) |
Men/women: 2/4 Age: 66.0 (6.5) BMI: 36.7 (8.4) |
EG: 6 CG: 6 |
CG + mini squats, step ups, sit to stand exercises; open-chained knee extension exercise with elastic band resistance; performing the concentric phase forcefully and as quickly as possible and perform the eccentric phase slowly and with control; initiated 2 years after surgery |
Monitoring of daily steps by wearing a pedometer to record the number of steps; patients were encouraged to walk 7500 to 10,000 steps daily |
6MWT | 8 | 3.5 | 25 | 423 |
| Quan HL 2022 China |
Men/women: 12/18 Age: 65.27 (6.49) Weight: 65.87 (7.01) kg Height: 1.64 (0.07) m |
Men/women: 17/13 Age: 66.23 (7.73) Weight: 66.07 (8.38) kg Height: 1.62 (0.07) m |
EG: 30 CG: 30 |
CG + hip abductors resistance training while supine, lying on side, and standing; side step and side upstairs; using sand packs or elastic bands for resistance |
Keeping the knee at straight position using sand packs; isotonic contraction of quadricep and hamstring muscle; ankle pump and straight leg raise without resistance 3 sets per day, 10 repetitions per set; patella mobilization; mobility training with walking aid; balance and proprioception training |
TUG | 4 | 5 | 40 | 12 |
| Sun Q 2022 China |
Men/women: 31/40 Age: 67.8 (4.05) BMI: 25.81 (2.37) |
Men/women: 31/39 Age: 67.4 (3.94) BMI: 26.14 (2.46) |
EG: 71 CG: 70 |
CG + hip extension-flexion and abduction–adduction exercises, knee extension-flexion exercises, ankle dorsiflexion-plantarflexion exercises | Physiotherapy, regular exercises, and weight-bearing exercises: up and down stairs, variable speed walking, and walking fast and stopping fast | TUG | 13 (90 days) | 7 | 30 | 47 |
EG experimental group, CG control group, BMI body mass index, ROM range of motion, 6MWT six-minute walk test, TUG timed-up and go.