JOA - 2026-06-02 - Journal Article
The Impact of Photographic Evidence on Postoperative Range of Motion Following Total Knee Arthroplasty: A Randomized Control Trial.
Farooq H, Howard J, Johnson B, Winter J, Dickens B, Brown NM
Topics
Key Takeaway
Providing postoperative ROM photographs to TKA patients improved knee extension by 3° at 6 weeks (0° vs 3°, P=0.01) but produced no clinically meaningful differences in flexion, PT metrics, or KOOS scores.
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Summary
This RCT tested whether providing TKA patients with intraoperative photographs of their knee in maximum flexion and extension would improve postoperative ROM and rehabilitation outcomes. 27 patients received photographs and 28 did not; primary outcome was 6-week knee flexion. The photograph group achieved statistically better extension (0° vs 3°, P=0.01) but no significant differences in flexion (118° vs 115°, P=0.12), PT duration, sessions, ambulation distance, or KOOS scores.
Key Limitation
The sample size of 55 patients is underpowered to detect clinically meaningful differences in secondary outcomes, and the 6-week endpoint captures only early rehabilitation, missing the period of greatest functional recovery.
Original Abstract
BACKGROUND
Improved function is a key goal following total knee arthroplasty (TKA). Providing patients who have postoperative photographic evidence of their knee range of motion (ROM) may encourage engagement in rehabilitation and improve outcomes.
METHOD
SA randomized controlled trial was conducted in which 27 patients received photographs of their knee in maximum flexion and extension immediately after surgery, while 28 patients did not. The primary outcome was knee flexion at six weeks postoperatively. The secondary outcomes included knee extension, physical therapy (PT) metrics, lengths of stay (LOS), and patient-reported outcomes via the Knee injury and Osteoarthritis Outcome Score (KOOS) survey. Baseline demographic characteristics and preoperative knee range of motion were similar between groups, with no significant differences observed.
RESULTS
At six weeks, patients who received photographs demonstrated significantly greater median knee extension (0 versus 3.0˚, P = 0.01. Although several outcomes, such as average knee flexion (118 versus 115˚, P = 0.12), distance walked on postoperative day one (30 versus 26 feet, P = 0.6), duration of physical therapy (10 versus 11 weeks, P = 0.7), number of sessions (16 versus 20 sessions, P = 0.5), time to achieve 110° flexion (4.5 versus 5 weeks, P = 0.2), and KOOS primary score (58.2 versus 52.1, P = 0.5), trended favorably for the photographic evidence group, none reached statistical or clinical significance.
CONCLUSION
Patients who received photographic evidence of their knee ROM did not demonstrate clinically meaningful improvements in ROM, PT outcomes, or KOOS scores at six weeks postoperatively. These findings suggest that photographic evidence may not offer major benefit as an adjunct to standard rehabilitation following TKA.