Effect of early hybrid assistive limb assisted rehabilitation on functional outcomes and patient satisfaction after total knee arthroplasty: a randomized controlled trial
DOI:
https://doi.org/10.2340/jrm.v58.43925Keywords:
knee osteoarthritis, early rehabilitation, robot rehabilitation, total knee arthroplastyAbstract
Background: Early rehabilitation within 4 h following total knee arthroplasty involves passive exercise with manual therapy.
Objective: The aim was to determine the beneficial effects of the single-joint hybrid assistive limb for
rehabilitation within 4 h after total knee arthroplasty.
Methods: This single-blinded randomized controlled trial included 68 participants who underwent primary total knee arthroplasty for knee osteoarthritis and were assigned to the early single-joint hybrid assistive limb (n = 22), HAL-SJ (n = 23), and control (n = 23) groups.
Results: The Knee Injury and Osteoarthritis Outcome Score quality of life (p = 0.007) scores of the early single-joint hybrid assistive limb group showed significantly higher values than the control groups at 12 months. The recovery time for extension lag was significantly improved in the early single-joint hybrid assistive limb group compared with the single-joint hybrid assistive limb (p = 0.006) and control (p < 0.001) groups. Additionally, the knee flexion range of motion of the early single-joint hybrid assistive limb group showed significantly higher values than the single-joint hybrid assistive limb (p = 0.029) and control (p = 0.031) groups at 1 week.
Conclusions: Early single-joint hybrid assistive limb rehabilitation may improve patient-reported quality of life at 12 months without exacerbating postoperative pain or swelling. These results suggest that the single-joint hybrid assistive limb may be a feasible adjunct to early postoperative rehabilitation after total knee arthroplasty, while further studies are required to clarify its clinical relevance and long-term benefits.
Downloads
References
Tuncay Duruoz M, Oz N, Gursoy DE, Hande Gezer H. Clinical aspects and outcomes in osteoarthritis. Best Pract Res Clin Rheumatol 2023; 37: 101855.
https://doi.org/10.1016/j.berh.2023.101855 DOI: https://doi.org/10.1016/j.berh.2023.101855
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet 2019; 393: 1745–1759.
https://doi.org/10.1016/S0140-6736(19)30417-9 DOI: https://doi.org/10.1016/S0140-6736(19)30417-9
Yang G, Wang J, Liu Y, Lu H, He L, Ma C, et al. Burden of knee osteoarthritis in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. Arthritis Care Res (Hoboken) 2023; 75: 2489–2500.
https://doi.org/10.1002/acr.25158 DOI: https://doi.org/10.1002/acr.25158
Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: a systematic review with meta-analysis. PLoS One 2017; 12: e0178295.
https://doi.org/10.1371/journal.pone.0178295 DOI: https://doi.org/10.1371/journal.pone.0178295
Henderson KG, Wallis JA, Snowdon DA. Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis. Physiotherapy 2018; 104: 25–35.
https://doi.org/10.1016/j.physio.2017.01.002 DOI: https://doi.org/10.1016/j.physio.2017.01.002
Chen AF, Stewart MK, Heyl AE, Klatt BA. Effect of immediate postoperative physical therapy on length of stay for total joint arthroplasty patients. J Arthroplasty 2012; 27: 851–856.
https://doi.org/10.1016/j.arth.2012.01.011 DOI: https://doi.org/10.1016/j.arth.2012.01.011
Prinsloo RM, Keller MM. Same-day discharge after early mobilisation and increased frequency of physiotherapy following hip and knee arthroplasty. S Afr J Physiother 2022; 78: 1755.
https://doi.org/10.4102/sajp.v78i1.1755 DOI: https://doi.org/10.4102/sajp.v78i1.1755
Kubota M, Kokubo Y, Miyazaki T, Matsuo H, Naruse H, Shouji K, et al. Effects of knee extension exercise starting within 4 h after total knee arthroplasty. Eur J Orthop Surg Traumatol 2022; 32: 803–809.
https://doi.org/10.1007/s00590-021-03042-9 DOI: https://doi.org/10.1007/s00590-021-03042-9
Labraca NS, Castro-Sanchez AM, Mataran-Penarrocha GA, Arroyo-Morales M, Sanchez-Joya Mdel M, Moreno-Lorenzo C. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clin Rehabil 2011; 25: 557–566.
https://doi.org/10.1177/0269215510393759 DOI: https://doi.org/10.1177/0269215510393759
Oktas B, Vergili O. The effect of intensive exercise program and kinesiotaping following total knee arthroplasty on functional recovery of patients. J Orthop Surg Res 2018; 13: 233.
https://doi.org/10.1186/s13018-018-0924-9 DOI: https://doi.org/10.1186/s13018-018-0924-9
Muertizha M, Cai X, Ji B, Aimaiti A, Cao L. Factors contributing to 1-year dissatisfaction after total knee arthroplasty: a nomogram prediction model. J Orthop Surg Res 2022; 17: 367.
https://doi.org/10.1186/s13018-022-03205-2 DOI: https://doi.org/10.1186/s13018-022-03205-2
Mrotzek SJ, Ahmadi S, von Glinski A, Brinkemper A, Aach M, Schildhauer TA, et al. Rehabilitation during early postoperative period following total knee arthroplasty using single-joint hybrid assistive limb as new therapy device: a randomized, controlled clinical pilot study. Arch Orthop Trauma Surg 2022; 142: 3941–3947.
https://doi.org/10.1007/s00402-021-04245-9 DOI: https://doi.org/10.1007/s00402-021-04245-9
Fukaya T, Mutsuzaki H, Yoshikawa K, Koseki K, Iwai K. Effect of training with the hybrid assistive limb on gait cycle kinematics after total knee arthroplasty. Geriatr Orthop Surg Rehabil 2021; 12: 21514593211049075.
https://doi.org/10.1177/21514593211049075 DOI: https://doi.org/10.1177/21514593211049075
Cai L, Liu Y, Wei Z, Liang H, Liu Y, Cui M. Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty. Res Nurs Health 2023; 46: 203–209.
https://doi.org/10.1002/nur.22290 DOI: https://doi.org/10.1002/nur.22290
Goto K, Morishita T, Kamada S, Saita K, Fukuda H, Shiota E, et al. Feasibility of rehabilitation using the single-joint hybrid assistive limb to facilitate early recovery following total knee arthroplasty: a pilot study. Assist Technol 2017; 29: 197–201.
https://doi.org/10.1080/10400435.2016.1219883 DOI: https://doi.org/10.1080/10400435.2016.1219883
Yoshikawa K, Mutsuzaki H, Sano A, Koseki K, Fukaya T, Mizukami M, et al. Training with hybrid assistive limb for walking function after total knee arthroplasty. J Orthop Surg Res 2018; 13: 163.
https://doi.org/10.1186/s13018-018-0875-1 DOI: https://doi.org/10.1186/s13018-018-0875-1
Watabe T, Ryota M, Sengoku T, Mizuno Y, Sakurai G, Yoshida S, et al. Safety and efficacy of early rehabilitation with assistance from a single-joint hybrid assistive limb in patients with total knee arthroplasty: a randomized controlled clinical pilot study. Cureus 2024; 16: e57738.
https://doi.org/10.7759/cureus.57738 DOI: https://doi.org/10.7759/cureus.57738
Kotani N, Morishita T, Saita K, Kamada S, Maeyama A, Abe H, et al. Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty. J Back Musculoskelet Rehabil 2020; 33: 413–421.
https://doi.org/10.3233/BMR-181482 DOI: https://doi.org/10.3233/BMR-181482
Wu K, Pan HH, Lin CH. Robotic exoskeletons and total knee arthroplasty: the future of knee rehabilitation and replacement – a meta-analysis. Medicine (Baltimore) 2024; 103: e37876.
https://doi.org/10.1097/md.0000000000037876 DOI: https://doi.org/10.1097/MD.0000000000037876
Maeda T, Sasaki E, Kasai T, Igarashi S, Wakai Y, Sasaki T, et al. Therapeutic effect of knee extension exercise with single-joint hybrid assistive limb following total knee arthroplasty: a prospective, randomized controlled trial. Sci Rep 2024; 14: 3889.
https://doi.org/10.1038/s41598-024-53891-7 DOI: https://doi.org/10.1038/s41598-024-53891-7
Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 2012; 10: 28–55.
https://doi.org/10.1016/j.ijsu.2011.10.001 DOI: https://doi.org/10.1016/j.ijsu.2011.10.001
Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64.
https://doi.org/10.1186/1477-7525-1-64 DOI: https://doi.org/10.1186/1477-7525-1-64
Collins NJ, Prinsen CA, Christensen R, Bartels EM, Terwee CB, Roos EM. Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. Osteoarthritis Cartilage 2016; 24: 1317–1329.
https://doi.org/10.1016/j.joca.2016.03.010 DOI: https://doi.org/10.1016/j.joca.2016.03.010
Kittelson AJ, Christensen JC, Loyd BJ, Burrows KL, Iannitto J, Stevens-Lapsley JE. Reliability, responsiveness, and validity of handheld dynamometry for assessing quadriceps strength in total knee arthroplasty. Disabil Rehabil 2021; 43: 3070–3077.
https://doi.org/10.1080/09638288.2020.1730454 DOI: https://doi.org/10.1080/09638288.2020.1730454
Meijer RS, Rietman JS, Geertzen JH, Bosmans JC, Dijkstra PU. Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema. Lymphology 2004; 37: 127–133
Cleland BT, Perez-Ortiz A, Madhavan S. Walking test procedures influence speed measurements in individuals with chronic stroke. Clin Biomech (Bristol, Avon) 2020; 80: 105197.
https://doi.org/10.1016/j.clinbiomech.2020.105197 DOI: https://doi.org/10.1016/j.clinbiomech.2020.105197
Watabe T, Sengoku T, Kubota M, Sakurai G, Yoshida S, Taniguchi Y. Knee injury and osteoarthritis outcome score and knee society score for the minimal clinically important differences after cruciate-retaining total knee arthroplasty: two-year follow up. Knee 2025; 53: 176–182.
https://doi.org/10.1016/j.knee.2024.12.015 DOI: https://doi.org/10.1016/j.knee.2024.12.015
Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 2010; 40: 250–266.
https://doi.org/10.1016/j.semarthrit.2009.10.001 DOI: https://doi.org/10.1016/j.semarthrit.2009.10.001
Yoshioka T, Kubota S, Sugaya H, Arai N, Hyodo K, Kanamori A, et al. Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty. J Rural Med 2021; 16: 22–28.
https://doi.org/10.2185/jrm.2020-024 DOI: https://doi.org/10.2185/jrm.2020-024
Yoshioka T, Sugaya H, Kubota S, Onishi M, Kanamori A, Sankai Y, et al. Knee-extension training with a single-joint hybrid assistive limb during the early postoperative period after total knee arthroplasty in a patient with osteoarthritis. Case Rep Orthop 2016; 2016: 9610745.
https://doi.org/10.1155/2016/9610745 DOI: https://doi.org/10.1155/2016/9610745
Watabe T, Muramatsu R, Sengoku T, Sakurai G, Yoshida S, Kubota M, et al. Effects of supplemental robot-assisted knee flexion exercise after total knee arthroplasty: a randomized controlled clinical study. J Musculoskelet Neuronal Interact 2025; 25: 178–185.
https://doi.org/10.22540/jmni-25-178 DOI: https://doi.org/10.22540/JMNI-25-178
Saita K, Morishita T, Arima H, Hyakutake K, Ogata T, Yagi K, et al. Biofeedback effect of hybrid assistive limb in stroke rehabilitation: a proof of concept study using functional near infrared spectroscopy. PLoS One 2018; 13: e0191361.
https://doi.org/10.1371/journal.pone.0191361 DOI: https://doi.org/10.1371/journal.pone.0191361
Morishita T, Inoue T. Interactive bio-feedback therapy using hybrid assistive limbs for motor recovery after stroke: current practice and future perspectives. Neurol Med Chir (Tokyo) 2016; 56: 605–612.
https://doi.org/10.2176/nmc.st.2016-0094 DOI: https://doi.org/10.2176/nmc.st.2016-0094
Oka T, Wada O, Asai T, Maruno H, Mizuno K. Importance of knee flexion range of motion during the acute phase after total knee arthroplasty. Phys Ther Res 2020; 23: 143–148.
https://doi.org/10.1298/ptr.E9996 DOI: https://doi.org/10.1298/ptr.E9996
Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS. Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? J Arthroplasty 2011; 26: 178–186.
https://doi.org/10.1016/j.arth.2010.02.008 DOI: https://doi.org/10.1016/j.arth.2010.02.008
Kubo M, Maeda T, Kumagai K, Amano Y, Kawasaki T, Imai S. Good postoperative flexion angle improves knee function and improvement of flexion angle increases patient satisfaction after total knee arthroplasty. J Arthroplasty 2021; 36: 3137–3140.
https://doi.org/10.1016/j.arth.2021.04.040 DOI: https://doi.org/10.1016/j.arth.2021.04.040
Published
How to Cite
License
Copyright (c) 2026 Takaya Watabe, Ryota Muramatsu, Takuya Sengoku, Goro Sakurai, Shinya Yoshida, Yuta Taniguchi
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
