The Impact of Photographic Evidence on Postoperative Range of Motion Following Total Knee Arthroplasty: A Randomized Control Trial

Background Improved function is a key goal following total knee arthroplasty. Providing patients who have postoperative photographic evidence of their knee range of motion (ROM) may encourage engagement in rehabilitation and improve outcomes. Methods A randomized controlled trial was conducted in which 27 patients received photographs of their knee in maximum flexion and extension immediately after surgery, while 28 patients did not. The primary outcome was knee flexion at six weeks postoperatively. The secondary outcomes included knee extension, physical therapy metrics, length of stay, and patient-reported outcomes via the Knee injury and Osteoarthritis Outcome Score (KOOS) survey. Baseline demographic characteristics and preoperative knee ROM were similar between groups, with no significant differences observed. Results At six weeks, patients who received photographs demonstrated significantly greater median knee extension (0 versus 3.0˚, P = 0.01. Although several outcomes, such as average knee flexion (118 versus 115˚, P = 0.12), distance walked on postoperative day one (30 versus 26 feet, P = 0.6), duration of physical therapy (10 versus 11 weeks, P = 0.7), number of sessions (16 versus 20 sessions, P = 0.5), time to achieve 110° flexion (4.5 versus five weeks, P = 0.2), and KOOS primary score (58.2 versus 52.1, P = 0.5), trended favorably for the photographic evidence group, none reached statistical significance or clinical relevance. Conclusions Patients who received photographic evidence of their knee ROM did not demonstrate clinically meaningful improvements in R OM, PT outcomes, or KOOS scores at six weeks postoperatively. These findings suggest that photographic evidence may not offer major benefit as an adjunct to standard rehabilitation following total knee arthroplasty. © 2026 Elsevier Inc.