Total knee arthroplasty (TKA) is a commonly performed procedure for advanced knee osteoarthritis. Despite successful surgery, many patients experience postoperative impairments including pain, reduced range of motion (ROM), swelling, impaired proprioception, and kinesiophobia, which may delay functional recovery.
Conventional physiotherapy is the standard rehabilitation approach following TKA; however, high-load strengthening exercises are often limited in the early postoperative phase due to pain and reduced tolerance.
Blood flow restriction (BFR) exercise is an emerging rehabilitation technique that enables low-load exercise to produce strength adaptations similar to high-intensity training. While evidence supports its effectiveness for improving muscle strength, its effects on other outcomes such as pain, swelling, proprioception, and kinesiophobia are not well established.
This randomized controlled trial will compare progressive BFR exercise combined with conventional physiotherapy versus conventional physiotherapy alone in patients following unilateral TKA. A total of 48 participants will be randomly allocated to two groups. The intervention will be delivered over 6 weeks with supervised sessions conducted three times per week.
Outcomes will include pain, knee ROM, swelling, proprioception, kinesiophobia, and functional performance. This study aims to determine whether BFR exercise provides additional benefits in postoperative rehabilitation following TKA.
Patients of age 50-65 years.
Primary unilateral TKA due to osteoarthritis.
Individuals with mild to moderate postoperative pain (NPRS score 4-7).
Minimum active knee flexion of 30° & an extension lag of no more than 15°.
History of deep vein thrombosis within the last six months.
Peripheral vascular disease and active infection.
Severe cardiovascular conditions
Neurological disorders affecting lower limb function
Parallel
Blood Flow Restriction Exercises and Conventional Physical Therapy
Other interventionParticipants in the experimental group will receive progressive blood flow restriction (BFR) exercise combined with conventional physiotherapy following total knee arthroplasty. BFR will be applied using a pneumatic cuff placed proximally on the operated thigh at 20-40% limb occlusion pressure. Low-load therapeutic exercises will be performed under cuff inflation, including quadriceps sets, straight leg raises, heel slides, ankle pumps, sit-to-stand training, gait training, and functional strengthening exercises. Sessions will be conducted three times per week for 6 weeks under physiotherapist supervision in addition to standard postoperative rehabilitation.
Conventional Physical Therapy alone
Other interventionParticipants in the control group will receive conventional physiotherapy following total knee arthroplasty. The rehabilitation program will include early mobilization, pain and swelling management, range of motion exercises, strengthening exercises, gait training, and functional activities such as ankle pumps, heel slides, quadriceps sets, straight leg raises, sit-to-stand training, and walking practice. Sessions will be conducted three times per week for 6 weeks under physiotherapist supervision along with a home exercise program.
Pain Intensity (Numeric Pain Rating Scale - NPRS)
Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), an 11-point self-reported scale ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will rate their level of pain at rest or during movement. The NPRS is a reliable and valid tool commonly used in musculoskeletal and postoperative populations. A decrease in NPRS score will indicate improvement in pain levels following the intervention.
Range of Motion
Knee range of motion will be measured using a standard universal goniometer. Active knee flexion and extension will be assessed in a standardized position by a trained assessor. Goniometric measurement is widely used and has good reliability in clinical settings. An increase in range of motion values will indicate improvement in joint mobility and functional recovery following total knee arthroplasty.
Swelling (Circumferential Measurement)
Knee swelling will be assessed using circumferential measurement with a non-elastic measuring tape at predefined anatomical landmarks around the knee joint. This method is commonly used in clinical practice and demonstrates good intra-rater reliability. A reduction in limb circumference will indicate a decrease in postoperative swelling.
Proprioception (Joint Position Sense Test - JPS)
Proprioception will be evaluated using the Joint Position Sense (JPS) test. The assessor will passively position the participant's knee at a target angle, and the participant will then attempt to actively reproduce the same position without visual feedback. The absolute angular error between the target and reproduced position will be recorded. Lower error values indicate improved proprioceptive accuracy and neuromuscular control.
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