Six-session non-operative exercise program yields sustained benefits for up to 18 months in end-stage knee osteoarthritis: a retrospective cohort study.

INTRODUCTION/

OBJECTIVES

Prolonged waiting times for total knee replacement (TKR) leave patients with end-stage knee osteoarthritis (OA) with persistent pain and functional limitation. We evaluated the effectiveness of a structured physiotherapy-led non-operative program for patients awaiting TKR.

METHOD: This retrospective cohort included 2,243 end-stage knee OA patients awaiting TKR (October 2021-March 2024). The Structured Non-Operative Treatment Program (SNTP) comprised six sessions delivered over one year, integrating aerobic, strengthening, neuromuscular exercises, and education to support lifestyle modification and home exercise adherence. Outcomes were assessed at baseline, program completion, and longitudinally thereafter; analyses focused on follow-up up to 2 years due to attrition. Primary outcomes were pain (Numeric Pain Rating Scale, NPRS), perceived change (Numeric Global Rating of Change, NGRCS), and knee function (Knee Injury and Osteoarthritis Outcome Score, KOOS).

RESULTS

Participants were stratified by baseline Knee Society Score (KSS): Poor (≤ 66), Fair (67-76), Good (77-89), and Excellent (90-100). Significant improvements were observed across most outcomes in all subgroups. Total KSS and KSS Function scores declined over time, consistent with progression in an end-stage cohort. Benefits were sustained up to 1.5 years in the Poor subgroup, 1 year in the Fair subgroup, and less than 1 year in the Good and Excellent subgroups.

CONCLUSIONS

A structured six-session programme was associated with sustained symptom relief in patients awaiting surgery, particularly among those with poorer baseline function. Severity-stratified progression strategies warrant further evaluation in controlled studies. Key Points • A scalable six-session physiotherapy-led programme improved pain and functional outcomes in patients with end-stage knee OA awaiting TKR. • Benefits were sustained for up to 18 months, particularly among patients with poorer baseline knee function. • Baseline severity modified durability of response, suggesting a need for severity-stratified progression and maintenance strategies.