The American Physical Therapy Association (APTA) recently released a 2026 update to its 2020 clinical practice guideline, Physical Therapist Management of Total Knee Arthroplasty. The new 2026 update features 20 recommendations regarding preoperative physical therapy, edema management strategies, neuromuscular electrical stimulation interventions, and more.
Today, we’re taking a look at some of the recommendations from the 2026 update to see how they compare to the 2020 guideline. For the complete look at all the recommendations featured in the 2026 release, view the full-text version.
Comparison of Recommendations
| Topic | 2020 | 2026 |
|---|---|---|
| Preoperative Physical Therapy | Physical therapists should design preoperative exercise programs and teach patients undergoing total knee arthroplasty (TKA) to implement strengthening and flexibility exercises. | Physical therapists should design and implement preoperative exercise programs for patients undergoing TKA to improve pre- and postoperative outcomes, including strength, flexibility, and endurance. Preoperative education may also incorporate neuroscience-based strategies to help manage pain and reduce procedure-related anxiety. |
| ROM Interventions | It is the consensus of the work group that physical therapists should teach and encourage patients to implement passive, active assistive, and active ROM exercises for the involved knee following TKA. | Physical therapists should not routinely use bracing or splinting in the early postoperative period to increase knee ROM for patients who have undergone primary, uncomplicated TKA. Physical therapists should design and implement treatment interventions for patients undergoing TKA that include passive, active-assistive, and active ROM exercises to optimize recovery and improve functional outcomes of the affected knee. Physical therapists may use manual therapy with exercise and/or devices to augment active-assistive exercise to improve ROM in the early postoperative period. |
| Nonpharmacological Pain Interventions | Physical therapists should teach patients and other care givers use of cryotherapy and encourage its use for early postoperative pain management for patients who have undergone TKA. | Physical therapists should teach and encourage use of cryotherapy for early postoperative pain management for patients who have undergone TKA. Physical therapists may use transcutaneous electrical nerve stimulation (TENS) (acute and subacute phases), Kinesio Taping (Kinesio, Albuquerque, NM, USA) (acute phase), manual therapy (time frame not specified), and/or psychologically informed techniques (time frame not specified) to decrease pain after TKA |
| Neuromuscular Electrical Stimulation (NMES) | Physical therapists should use NMES for patients who have undergone TKA to improve quadriceps muscle strength, gait performance, performance-based outcomes, and patient-reported outcomes. | Physical therapists should apply neuromuscular electrical stimulation (NMES) at least daily to the quadriceps for patients who have undergone TKA, initiated in the early postoperative period at the highest tolerable intensity, to improve quadriceps muscle strength, gait performance, and performance-based outcomes. |
| Swelling/Edema Management | To reduce immediate postoperative blood loss and swelling in the first 7 days after surgery, physical therapists or other team members may teach patients to position the operated knee in some degree of flexion (30°-90°) while resting. | To minimize risk of immediate postoperative swelling/edema, physical therapists and/or other team members should prescribe cryotherapy treatment and teach positioning of the surgical limb in an elevated position with 30 to 90 degrees of knee flexion during the early postoperative period after TKA. Physical therapists may consider Kinesio taping after uncomplicated TKA to reduce postoperative swelling/edema; however, evidence is mixed regarding its benefit. In the absence of sufficient quality evidence, it is the opinion of this work group that physical therapists should not routinely use manual lymphatic drainage (MLD), compression dressings, or CPM to reduce postoperative swelling/edema following TKA, as these interventions have not been proven effective. |
| Physical Therapy Delivery Methods | Supervised physical therapist management should be provided for patients who have undergone TKA. The optimal setting should be determined by patient safety, mobility, and environmental and personal factors. Physical therapists may use group-based or individual-based physical therapy sessions for patients who have undergone TKA. | Supervised physical therapist management should be provided for patients who have undergone TKA. The optimal setting should be determined by patient safety, mobility, and environmental and personal factors. Physical therapists may use group-based or individual-based physical therapy sessions for patients who have undergone TKA. Physical therapists and patients should consider use of digital health tools after TKA, either in addition to in-clinic care or as an alternative to in-clinic care. |
| Postoperative Care Settings | Not addressed. | When possible, postoperative physical therapy after TKA may take place in an outpatient setting rather than in inpatient rehabilitation or at home. |
| Postoperative Care Coordination | It is the consensus of the work group that physical therapists should provide guidance to the care team and to the patient on safe and objective discharge planning, patient functional status, assistance equipment, and services needed to support a safe discharge from the acute care setting. | In the absence of sufficient information, it is the opinion of this work group that physical therapists should collaborate in pre- and postoperative care coordination within an interdisciplinary team to optimize outcomes in patients undergoing TKA. |
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