Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026.
Allyn M Bove, Lindsay A Carroll, Sean Cone and 7 others
The revised TKA guideline tells PTs to do prehab, progressive strength training, and NMES, and to stop using CPM, bracing, and splinting.
Start therapy within 24 hours of surgery. No single ROM exercise method beats another.
Key findings
1CPM devices provide no meaningful clinical benefit after primary TKA and should not be used, given their cost and resource demands.
2Preoperative exercise improves early postoperative strength, function, and pain, but these benefits tend to diminish over time and no specific exercise modality or delivery setting has been shown superior.
3Progressive strength training beginning in the early postacute period improves muscle strength, functional performance, and balance, supported by seven high-quality studies.
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What it does not show
Prehabilitation benefits are short-term; the guideline notes limited evidence for sustained effects beyond 1.5 months. No study has identified a superior exercise modality, clinical setting, or supervision level for prehab, so the recommendation is broad. Kinesio Taping, MLD, and compression dressings for edema have inconsistent or insufficient evidence; the guideline cannot confirm or rule them out. No studies directly evaluated physical-therapist-driven care coordination protocols, so that recommendation is consensus-based with no supporting trial. Digital health tool evidence is too heterogeneous in tools, timing, and outcomes to support specific implementation guidance. The guideline covers primary TKA for osteoarthritis only; it does not apply to revision, partial knee, pediatric, or non-osteoarthritis patients. Several moderate-quality studies had methodological concerns including high participant attrition and improper randomization.
Declared interests
The American Physical Therapy Association funded the project and selected the physical therapist members of the guideline group but stated it played no role in design, conduct, or reporting of recommendations. AAOS provided paid methodological consulting. No peer reviewers or public commenters declared conflicts of interest requiring management.
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