Effects of Progressive Restricted Blood Flow Exercises in Post Total Knee Arthroplasty

Total knee arthroplasty (TKA) is a commonly performed procedure for advanced knee osteoarthritis. Despite successful surgery, many patients experience postoperative impairments including pain, reduced range of motion (ROM), swelling, impaired proprioception, and kinesiophobia, which may delay functional recovery. Conventional physiotherapy is the standard rehabilitation approach following TKA; however, high-load strengthening exercises are often limited in the early postoperative phase due to pain and reduced tolerance. Blood flow restriction (BFR) exercise is an emerging rehabilitation technique that enables low-load exercise to produce strength adaptations similar to high-intensity training. While evidence supports its effectiveness for improving muscle strength, its effects on other outcomes such as pain, swelling, proprioception, and kinesiophobia are not well established. This randomized controlled trial will compare progressive BFR exercise combined with conventional physiotherapy versus conventional physiotherapy alone in patients following unilateral TKA. A total of 48 participants will be randomly allocated to two groups. The intervention will be delivered over 6 weeks with supervised sessions conducted three times per week. Outcomes will include pain, knee ROM, swelling, proprioception, kinesiophobia, and functional performance. This study aims to determine whether BFR exercise provides additional benefits in postoperative rehabilitation following TKA.

Inclusion Criteria: 1. Patients of age 50-65 years. 2. Primary unilateral TKA due to osteoarthritis. 3. Individuals with mild to moderate postoperative pain (NPRS score 4-7). 4. Minimum active knee flexion of 30° \& an extension lag of no more than 15°. 5. Patients should be medically stable, cognitively able to follow instructions in Urdu or english, and willing to provide written informed consent Exclusion Criteria: 1. History of deep vein thrombosis within the last six months. 2. Peripheral vascular disease and active infection. 3. Severe cardiovascular conditions 4. Neurological disorders affecting lower limb function