Pedaling-Based Protocol Superior to a Ten-Exercise, Non-Pedaling Protocol for Postoperative Rehabilitation Following Total Knee Replacement: A Randomized Controlled Trial.

INTERVENTION: The Intervention or "Pedalling" group will be given a modified physiotherapy protocol with the main exercise being stationary pedalling on a set of floor pedals, it will also include gait retraining and walking as well as a knee extension (straightening) stretch. A senior orthopaedic physiotherapist will be delivering both the Intervention and Control group physiotherapy protocols. In the hospital setting, the twice daily 20‐minute physiotherapy session will consist of 2 exercises (pedalling and a knee extension stretch, gait retraining & aid prescription and practice of functional activities such as transfers and stair climbing. 8 minutes will be dedicated to the bike pedalling activity, 2 minutes to the extension stretch, and the other 10 minutes towards gait retraining and achievement of functional goals for discharge such as independent transfers and mobility. Once discharged the patient will continue with this home exercise program twice daily for 20 minutes and will be given a diary to tick off daily to calculate compliance, they are asked to return the diary to the assessor at their 2‐week review. As patients will be independent with transfers and mobility on discharge, an increased time can be spent on their home exercise program which consists of the same exercises in hospital and should be split, 10 minutes on pedalling, 5 minutes of knee extension stretching, and 5 minutes spent on gait training with an emphasis on heel‐toe strike. Both the Intervention and Control groups will commence physiotherapy on the day of surgery and undergo the same twice daily inpatient physiotherapy sessions post total knee replacement surgery, the time of each session will be approximately 20 minutes. This is no different than the standard frequency and duration of current inpatient physiotherapy sessions. Patients are instructed not to see an outpatient physiotherapist between discharge and their 2 week follow up assessment. CONDITION: Osteoarthritis Total Knee Replacement PRIMARY OUTCOME: 10 meter timed walk test ; 6 minute walk test EuroQol 5 Dimensions (EQ5D) Health Outcome Measure Questionnaire SECONDARY OUTCOME: "Time at which the patient is deemed safe for discharge" this is routinely decided by the orthopaedic physiotherapist at our institution and is dependent on the achievement of the following functional goals: ; Independent transfers ; Independent mobility (with aid for discharge) ; Completed stairs practice ; Achieved 90 degrees knee flexion at any point during post‐operative hospital stay ; ; Analgesia Consumption, recorded by review of the medication chart from the patient's hospital medical record. Specifically, Oxycodone which is prescribed for "breakthrough" pain relief, and is prescribed as "PRN" or "as needed". Knee flexion ROM Oxford Knee Score Pain Threshold self‐reported Likert Scale Patient Satisfaction with Physiotherapy self‐reported Likert scale Timed Up and Go 3 meter walk test INCLUSION CRITERIA: Patients of one particular Orthopaedic Surgeon at our Institution undergoing primary unilateral total knee replacement surgery with a primary diagnosis of osteoarthritis.