Design: Single-blinded randomised controlled trial
Population: 58 patients having primary total knee arthroplasty
Primary outcome: Isokinetic knee muscle strength over 12 months
Effect: Higher strength and flexion at day 5 (p < 0.05); no difference at 3, 6 or 12 months

This single-blinded randomised trial assigned 58 patients having primary total knee arthroplasty to a modified enhanced recovery protocol (31) or conventional perioperative care (27). Isokinetic quadriceps and hamstring strength was measured on a dynamometer at five days, four weeks, and three, six and twelve months, alongside pain scores and knee outcome scores.

At five days the enhanced recovery group had significantly greater muscle strength and better active flexion. Those differences narrowed and were not significant at three, six or twelve months. Satisfaction and knee outcome scores were high and similar in both groups at one year.

The trial is small, and the protocol is described only as modified, so it is hard to say which element drove the early gain. What it does show is that faster early mobilisation did not cost anything later. For units still weighing an enhanced recovery pathway, that is reassuring; for those already running one, it confirms the benefit is early function rather than a different final result.

Expect enhanced recovery to speed early strength and flexion rather than change one-year results.
Use early gains to support earlier discharge and mobilisation, not to promise a better final knee.
Measure early function locally if you introduce a pathway, since the benefit shows up in the first week.
Keep rehabilitation going beyond discharge; the groups converged by three months.

Why it matters

The case for enhanced recovery after knee replacement rests on the first weeks, and that is where it delivered.

The statistics, in plain English

With 58 patients, the trial could detect a large early difference but could easily miss a small later one. 'No significant difference' at one year therefore means no large difference, not proof the groups were identical.