Active heel-slide exercise therapy facilitates the functional and proprioceptive enhancement following total knee arthroplasty compared to continuous passive motion

Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3352-3360. doi: 10.1007/s00167-020-06181-4. Epub 2020 Aug 10.


Purpose: The aim was to compare active heel-slide exercise (AHSE) + standard physiotherapy (PT) to continuous passive motion (CPM) + standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of postoperative outcomes.

Methods: Patients were randomly assigned into AHSE or CPM groups. Both groups received standard PT (range of motion and strengthening exercises, and ambulation) during hospital stay. Patients were evaluated regarding functional outcomes, knee proprioception, pain intensity, active range of motion, knee circumference, length of hospital stay, time for achieving straight leg raise actively, time for achieving 70° knee flexion.

Results: Groups were similar at baseline (n.s.). At discharge, AHSE group was better in terms of pain intensity (p < 0.001), Hospital for Special Surgery knee score (p = 0.001), rise from sitting (p = 0.015), ascend/descend stairs (p = 0.038), and timed up and go test (p = 0.028) compared to CPM group. AHSE group was able to perform the straight leg raise earlier than CPM group during inpatient period (p = 0.001) and demonstrated improved proprioception at discharge and at 3-month follow-up (p < 0.05). No statistical differences were detected between groups in other evaluation parameters (n.s.).

Conclusion: Our findings support AHSE therapy offers a more functional rehabilitation and leads beneficial results for patients following TKA. Therefore, active exercise approach encouraging patients to participate in their rehabilitation should be first choice in acute postoperative rehabilitation following TKA rather than CPM.

Level of evidence: II.

Keywords: Active heel-slide exercise; Continuous passive motion; Functional outcome; Knee arthroplasty; Physiotherapy; Proprioception.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Arthroplasty, Replacement, Knee*
  • Exercise Therapy
  • Heel
  • Humans
  • Motion Therapy, Continuous Passive
  • Postural Balance
  • Proprioception
  • Range of Motion, Articular
  • Time and Motion Studies
  • Treatment Outcome