Therapeutic exercise, clinical decision-making, and transition to arthroplasty in knee osteoarthritis: A narrative review
DOI:
https://doi.org/10.62827/fb.v27i8.1295Keywords:
Rehabilitation; Decision Making; Quality of Life; Osteoarthritis; Exercise Therapy.Abstract
Introduction: Therapeutic exercise and arthroplasty are components of care for adults with symptomatic knee osteoarthritis, but exercise evidence covers broader populations, whereas direct comparisons with surgery involve selected patients eligible for the procedure. Objective: To analyze benefits, limitations, and criteria guiding the transition from conservative treatment to surgery. Methods: Narrative review with a PubMed search updated on September 18, 2026, consultation of institutional guidelines, and citation tracking. Publications from 2021 to 2026 were prioritized, while landmark trials and earlier follow-up reports were retained. The synthesis distinguished direct comparisons, observational studies, reviews, and guidelines. Results: Exercise improved pain and function, with variable magnitude. In patients eligible for surgery, arthroplasty combined with conservative treatment provided greater benefit than conservative treatment alone, with more serious adverse events. In studies without a group unexposed to exercise, some patients chose to postpone surgery; this finding neither establishes causality nor demonstrates functional recovery. Conclusion: Multimodal programs prevent their effects from being attributed exclusively to exercise. An established indication should not be prolonged automatically through further physiotherapy courses, and rehabilitation remains relevant when surgery is chosen. Exercise is a core treatment; arthroplasty is an option for persistent substantial limitations despite appropriate conservative care or when such care is unsuitable. Treatment selection requires functional reassessment, careful consideration of evidence applicability, and shared decision-making.
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Copyright (c) 2026 Rafael Viana dos Santos Coutinho, Emerson de Oliveira Pimenta, João Vitor Montenegro Silva, Antonio Andrei Pinho Braga, Izabela Pedrosa Caputo Arantes (Autor)
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