Effectiveness and cost-effectiveness of a novel rehabilitation strategy in people undergoing primary total knee replacement surgery. The MARKER (Maximum Recovery After Knee Replacement Surgery) Study.

Novel rehabilitation strategy, consisting of rehabilitation provided in 2 stages. Stage 1: Initial home exercise programme (usually Week 1 to 6 after hospital discharge). The exercises will focus on maintaining and improving active knee flexion and extension range of motion. Participants will perform 5 to 10 times of 3 to 5 exercises 3 times per day. Participants’ progress, including adherence to the home exercise programme, walking ability and knee symptoms will be monitored weekly by a research physiotherapist, with clinic visits in the first one or two weeks and by telephone calls thereafter. Stage 2: Outpatient exercise classes (usually Week 6 to 14 after hospital discharge) About four weeks after total knee replacement surgery, a research physiotherapist will commence screening during the weekly telephone calls to assess eligibility to commence the classes: (i) surgical wound healed, (ii) full weight-bearing tolerated on the operated limb, (iii) ambulating independently outdoors for more than 50 m, and (iv) not requiring daily opioid-based analgesics for knee pain. The exercise classes will be circuit-based and supervised by a physiotherapist. The one hour classes will be conducted twice a week for eight weeks. Each class will consist of a warm up and cool down component, progressive functional and strengthening exercises, and a 20-minute monitored aerobic exercise session on stationary bicycles. At the beginning of each exercise class, knee pain, range of motion and swelling will be evaluated to allow appropriate exercise progression. Class size will be restricted to a maximum of six participants. Participants will be required to do at least one additional intensive exercise session per week at home, consisting of 30 minutes of walking outdoors or stationary bicycle. In addition, one education class will be provided to participants, focusing on the rationale for increasing lower limb muscle strength and beneficial lifestyle behaviours appropriate after total knee replacement.