Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026.

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.

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.

Do not read the strong 'do not use CPM' recommendation as applying to every post-knee-surgery patient. The evidence base is specifically for primary, uncomplicated TKA for osteoarthritis, and the guideline explicitly excludes revision surgery, partial knee arthroplasty, and non-osteoarthritis indications. Also, several moderate- and weak-strength recommendations (Kinesio Taping, MLD, group vs individual PT) rest on small or heterogeneous evidence and should not be treated as settled practice.