Efficacy of hydrotherapy versus gym treatment in primary total knee prosthesis due to osteoarthritis: a randomized controlled trial

Background. Physiotherapy is postulated as an effective treatment after total knee arthroplasty (TKA) due to osteoarthritis. The aim was to assess the efficacy of hydrotherapy versus gym kinesitherapy during the second phase of treatment in TKA patients, with regard to the improved gait test, pain, stiffness, joint balance, muscle strength and inflammation. Methods. A controlled and randomized trial was carried out. TKA patients received a first rehabilitative phase (15 60-minutes sessions) at the gym. In the second phase (15 40-minute sessions), one group performed physiotherapy in a gym and another in a swimming pool. Different variables were assessed (basal, after 15 and after 30 sessions): functional capacity, pain and stiffness with WOMAC index, joint balance with goniometer; muscle strength with Lovett scale, and result of 6-minute gait test. Results. A total of 115 patients participated, 59 (51.3%) in the gym group and 56 (48.7 %) in the pool group. After the second phase of rehabilitation, higher clinical improvements were observed in the pool group, with statistically significant differences in pain (p= 0.005), stiffness (p = 0.010), joint balance (p = 0.027) and muscle strength (p = 0.049) in the operated knee, and in the result of the 6-minute gait test (p = 0.002). Conclusions. In TKA patients, hydrotherapy during the second phase of rehabilitative treatment was more effective than gym physiotherapy in terms of improved pain, stiffness, joint balance, muscle strength and gait testing.