Active Physical Exercise Improves Functional Knee Recovery and Quality of Life Without Increasing the Risk of Complication in Patients with Endoprosthetic Knee Replacement for Bone Tumor

Objectives To explore whether active physical exercise (APE) is more effective than conventional continuous passive motion (CPM) in improving functional knee recovery and quality of life without increasing the risk of complication in patients with endoprosthetic knee replacement for bone tumor. Methods Six hundred and fourteen patients were enrolled and allocated to either APE or CPM for 6 months. APE was specific for patients with bone tumors on the distal femur (APE-F) and proximal tibia (APE-T), whereas CPM was similar to both types of patients (CPM-F and CPM-T). APE for both APE-F and APE-T patients was started on the second post-operation day, and CPM was initiated on the second post-procedure day in CPM-F patients, and in the seventh post-procedure week in CPM-T patients. The 6-month APE training consisted of three stages with training intensity progressively increasing though limited within a range of metabolic equivalent (MET) on each stage. Training intensity was individualized based on personal basic MET. The patients were followed up for 5 years for regular assessments of functional knee recovery, quality of life, and rate of complications. Results APE-F and APE-T patients presented with significantly better results in functional knee recovery and quality of life in comparison with CPM-F and CPM-T patients, respectively. In addition, APE-T patients reached a similar level of quality of life as APE-F patients 6-month post-operation, whereas CPM-T patients reached a similar level of quality of life as CPM-F patients 3 years after the procedure. Nevertheless, APE training did not induce a higher incidence of complications than CPM training. Conclusions APE training was more effective in improving functional knee recovery and quality of life without increasing the risk of complications than CPM training, thus, being strongly recommended to the patients for post-operation rehabilitation. Trial registration : ChiCTR2200061774