Osteoarthritis (OA) is a common degenerative joint disease causing cartilage damage, bone erosion, and chronic pain, often leading to disability. Total knee arthroplasty (TKA) is frequently performed to relieve OA symptoms. Conventional therapy training (CTT) is the standard intervention, whether preoperative or postoperative. We assume that intensive therapy training (ITT) may have higher effects in some aspects. The study aims to evaluate the impact of postoperative CTT versus ITT on various physical measures and questionnaires over different follow-up periods. Our systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, searching until June 2024. We assessed the risk of bias using the Cochrane Risk of Bias 2 (ROB (2) tool. Data were analyzed using Review Manager 5.4 (Cochrane Collaboration, London, UK), with mean differences (MD) and 95% confidence intervals (CI), and heterogeneity was assessed via P-value and I2 tests. The study consisted of 1087 patients. In the first month of follow-up, ITT did not significantly reduce pain on the visual analog scale (VAS) compared to CTT, with similar results at three and 12 months (overall MD -0.38, 95% CI -1.56 to 0.8, p = 0.53). For Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, ITT showed significant improvement within the first week and at one month (MD -14.60 and MD -3.11, respectively), but not at later follow-ups. In range of motion (ROM) flexion, ITT significantly improved outcomes in the first week (MD 8.60, p = 0.001), but showed no significant differences at one and three months. No other outcomes showed any significant difference, and both results in ITT and CTT were similar. In TKA rehabilitation, ITT provides early benefits, particularly in improving ROM flexion and WOMAC scores during the initial postoperative week. However, ITT does not show significant advantages over CTT in terms of walking distance, quadriceps strength, ROM extension, or pain reduction throughout various follow-up periods. While ITT offers slight early gains, it does not present long-term benefits over CTT. Incorporating preoperative training into the postoperative regimen may be beneficial. We recommend that high-intensity exercises may not be necessary, as they yield similar results to conventional methods. However, further research is needed to explore both early and long-term outcomes that are not fully addressed in current studies.

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