Telerehabilitation After Total Knee Arthroplasty: A Narrative Review of Its Effectiveness, Safety, and Access in the Post-COVID Era.

Osteoarthritis (OA) is a leading cause of disability worldwide, affecting primarily older adults. With rising rates of obesity and population aging, the global burden of OA is expected to grow substantially. Total knee arthroplasty (TKA) remains the definitive treatment for end-stage knee OA. However, the growing demand for postoperative rehabilitation has intensified the strain on the physical therapy (PT) workforce. The COVID-19 pandemic accelerated the adoption of telerehabilitation, but evidence regarding its effectiveness, safety, cost-efficiency, and equity after TKA remains scattered. A narrative review of English-language, full-text articles published between January 2018 and May 2025 was performed. PubMed, MEDLINE, and Google Scholar were searched using terms including "telerehabilitation", "virtual physical therapy", and "total knee arthroplasty". Eligible studies were randomized controlled trials (RCTs), cohort studies, case series (n ≥ 10), or systematic reviews/meta-analyses that compared telerehabilitation with conventional in-person rehabilitation after TKA. Outcomes included functional metrics, e.g., Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Knee Society Score (KSS), pain (visual analog scale, VAS), patient satisfaction, adherence, cost/utilization data, and equity indicators. Eight studies (six RCTs, two meta-analyses; n ≈ 2,070) met the inclusion criteria. Interventions included AI-driven apps, video-based therapy, and wearable sensors. Most studies found telerehabilitation to be non-inferior to conventional PT in improving pain, range of motion (ROM), and function. Meta-analyses showed comparable gains in KOOS, ROM, and VAS scores. Cost-effectiveness was favorable in bundled care models, though technology costs were inconsistently reported. No increased adverse events were observed. Digital literacy and broadband access emerged as equity challenges. Telerehabilitation is a safe, effective adjunct to in-person PT following TKA, with potential to expand access and reduce system strain. Hybrid models may offer the most sustainable path forward.