Effects of open and closed kinetic chain exercises on pain, swelling, knee range of motion and function after total knee replacement

Objective: The aim of this study was to investigate the effects of open kinetic chain exercises (OKCE) and closed kinetic chain exercises (CKCE) on pain, swelling, knee range of motion (ROM) and function after bilateral total knee arthroplasty (TKA). Method: 36 patients who underwent a bilateral TKA, with a mean age of 65,22 (51-79) years, were included in the study. The patients were randomly assigned to either OKCE group (n=18) or CKCE group (n=18). First, all patients received the same early physiotherapy program during first three days in the hospital, then the same standard home program was given after discharge. In the second week of the post-operative period, according to the group, OKCE or CKCE were started. Exercises were done 3 days a week, through 6 weeks, and progressed gradually. Pain intensity (Visual Analog Scale), swelling (circumference measurement), active and passive knee range of motion (ROM) (using universal goniometer) were evaluated before training, 2nd week and 6th week after training program. Functional status (WOMAC) assessment was performed at last follow-up. Results: At baseline, the anthropometric characteristics, pain intensity, and ROM of the patients in both groups were similar (p>0.05). The OKCE and the CKCE groups showed clinically meaningful improvements in pain severity, swelling and knee ROM as compared to first measurements (p<0.05). While pain intensity significantly decreased between first and third measurements in the OKCE group (p<0.05), it remained unchanged in CKCE group (p>0.05). When the mean differences of intra-group changes between groups were compared, similar improvements were observed in pain intensity and knee ROM (p>0.05), except for swelling. Moreover, there were no significant differences between WOMAC scores of the groups at the 6th week (p> 0.05). Conclusion: CKCE program did not result in greater improvements in pain, swelling, knee ROM and functional activities when compared with OKCE program in patients with bilateral TKA. However, our results suggested that CKCE could be added to early post-acute rehabilitation programs.