Telerehabilitation Is a Valid Option for Total Knee Arthroplasty Patients: A Retrospective Pilot Study Based on Our Experience during the COVID-19 Pandemic

Introduction: Total knee arthroplasty is an effective operation. Post-surgery rehabilitation, based on early and intensive progressive exercise programs, plays a substantial role and telerehabilitation can be an effective safe option. This retrospective study aimed to compare traditional in-presence rehabilitation and telerehabilitation for total knee arthroplasty, based on our experience during the Italian COVID-19 lockdown. Materials and methods: We retrospectively analyzed 164 patients (94 females and 70 males) enrolled in 2020 within 2 weeks after total knee replacement to perform post-operative outpatient rehabilitation. The clinical results of 82 patients (mean age 66.8 & PLUSMN; 10.2 years) performing telerehabilitation with those obtained from a similar cohort of 82 patients (mean age 65.4 & PLUSMN; 11.8 years) performing traditional in-presence outpatient rehabilitation were compared. Clinical outcomes were examined by comparing the gait speed (Time Up and Go-TUG test), the range of motion, the pain intensity (VAS), the functional status (Oxford Knee Score-OKS and Knee injury and Osteoarthritis Outcome Score-KOOS) and the overall satisfaction (Self-administered patient satisfaction scale) 12 weeks after the beginning of the physiotherapeutic protocol. Results: Telerehabilitation was non-inferior to traditional in-presence rehabilitation in all of the investigated areas and no statistical difference in terms of effectiveness was detected at 12 weeks, as confirmed by the respective patient-reported outcome scores such as TUG test (reduced from 20 & PLUSMN; 2 s to 12 & PLUSMN; 1.5 s for the telerehab cohort and from 18 & PLUSMN; 1.5 s to 13.1 & PLUSMN; 2 s for the in-presence rehabilitation one), pain VAS, OKS (improved from 22 & PLUSMN; 1.3 to 36 & PLUSMN; 2.7 for the telerehab cohort and from 23 & PLUSMN; 2.1 to 35.1 & PLUSMN; 4.2 for the in-presence group), KOOS (improved from 46.2 & PLUSMN; 10.2 to 67.4 & PLUSMN; 3.8 for the telerehabilitation cohort and from 48.4 & PLUSMN; 8.4 to 68.3 & PLUSMN; 6.6 for the other group), and the Self-administered patient satisfaction scale (more than two-thirds of patients globally satisfied with the results of their surgery in both groups). Conclusion: The telerehabilitation program was effective after total knee replacement and yielded clinical outcomes that were not inferior to conventional outpatient protocols.