OBJECTIVE: To evaluate the efficacy and safety of progressive resistance exercise (PRE) for patients with total knee arthroplasty (TKA) in a meta-analysis. DATA SOURCES: PubMed, Medline, Cochrane's Library, and Embase databases. STUDY SELECTION: Randomized controlled trials evaluating the effect of PRE on mobility and function in TKA patients. DATA EXTRACTION: A random-effect model was applied if significant heterogeneity was detected; otherwise, a fixed-effect model was applied. DATA SYNTHESIS: Seven RCTs. Compared to a rehabilitation program without PRE, physiotherapy including PRE was associated with improvements in the 6-minute walking test (weighed mean difference (WMD) 19.22 m, p = 0.04) with a wide confidence interval (CI 0.48 to 37.95). However, sensitivity analysis by omitting one study with preoperative rehabilitation revealed non-significant results (WMD 15.15m, p = 0.16). Moreover, PRE did not significantly improve the maximal walking speed (WMD 0.05 m/s, 95% CI 0.00 to 0.11, p = 0.05). However, PRE was associated with improved knee strength of extension (standard mean difference (SMD) 0.72, 95% CI 0.47 to 0.96, p < 0.001) and flexion (SMD 0.47, 95% CI 0.19 to 0.74, p < 0.001), but not self-reported physical function (SMD -0.17, 95% CI -0.37 to 0.03, p = 0.10) or changes in pain score (SMD 0.11, 95% CI -0.15 to 0.37, p = 0.40). PRE did not increase the risk of adverse events (risk ratio 1.19, 95% CI 0.52 to 2.71, p = 0.68). CONCLUSIONS: PRE may lead to improvements in physical function among patients receiving a TKA. PRE leads to higher ultimate strength in the surgical knee and is safe to perform.

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