Structured exercise may ease fear of movement after knee replacement

Design

Systematic review and meta-analysis of randomised trials

Population

1,096 adults after primary total knee arthroplasty, 11 trials

Primary outcome

Kinesiophobia

Effect

SMD −1.22 (95% CI −1.72 to −0.72); I² 93%, low certainty

A meta-analysis pooled 11 randomised trials of 1,096 adults after primary total knee arthroplasty, comparing exercise-based rehabilitation programmes with routine postoperative rehabilitation.

Exercise-based programmes were associated with less kinesiophobia (SMD −1.22, 95% CI −1.72 to −0.72) and better knee function (SMD 1.19), but heterogeneity was extreme (I² 93%) and certainty low. The early pain benefit was not robust.

Fear of movement affects roughly a fifth to a third of patients after knee replacement and slows rehabilitation. The direction of effect is consistent, but the size is unreliable, so this supports attention to fear of movement rather than any specific programme.

• Ask patients after knee replacement whether they are afraid to move or bend the knee
• Explain that some pain with exercise is expected and not a sign of damage
• Refer early to physiotherapy when fear is limiting progress
• Set graded, specific activity goals rather than general advice to 'keep moving'

Why it matters

Fear of movement is common after knee replacement and is often missed while attention is on the wound and range of motion.

Don't overread it

Low-certainty evidence with extreme heterogeneity — the effect size is not dependable.

The statistics, in plain English

An SMD above 1 would be a large effect, but an I² of 93% means the trials disagreed a great deal, so the pooled number is unreliable. Low certainty means further trials could change the estimate.

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