Early Exercise Rehabilitation Enhances Gait Following Endoprosthetic Knee Reconstruction for Bone Tumors: A Systematic Review and Meta-Analysis.

Endoprosthetic knee replacement after bone tumor resection is a critical limb-salvage procedure, yet patients often experience persistent gait abnormalities that hinder recovery and quality of life. Few studies have focused on the effects of exercise training on gait and functional ambulation, and potential time-response relationships between exercise training and outcomes remain unclear. We aimed to conduct a systematic review and meta-analysis to evaluate the effect of exercise training on gait. We also aimed to propose a rehabilitation protocol based on state-of-the-art evidence. A systematic search was conducted on databases including MEDLINE, Web of Science, Google Scholar, Cochrane, and Embase following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies assessing gait following exercise training in patients after endoprosthetic knee reconstruction were included. Three controlled clinical studies with 576 patients met the inclusion criteria. The pooled effect size was moderate, with Hedges' g for TUG (Timed Up and Go) being -0.569 (95% CI: -0.597 to -0.540). More complex gait parameters showed modest, nonsignificant improvements, particularly when rehabilitation was initiated later. Early structured rehabilitation meaningfully enhances gait symmetry, walking speed, and balance control in patients undergoing knee endoprosthetic replacement after tumor resection. The integration of timely, individualized exercise programs into standard postoperative care may maximize functional recovery and improve mobility.