Frontiers in Physiology · Nov 11, 2026
Bilateral prehabilitation combining blood flow restriction and high-load resistance training improves preoperative reserve and early recovery following total knee arthroplasty
By Franz A, Steffens PM, Baerschneider L et al.
Purpose: Persistent deficits in muscle strength and physical function remain common after total knee arthroplasty (TKA). This study investigated whether a bilateral prehabilitation program combining low-load blood flow restriction (BFR) resistance training of the operative limb with conventional high-load resistance training of the contralateral limb improves preoperative muscular reserve and postoperative recovery. Methods: In this prospective RCT, 19 patients scheduled for primary TKA completed a six-week bilateral prehabilitation program. Participants were randomized to either low-load resistance training with BFR (60% limb occlusion pressure) or a sham-BFR control intervention for the operative limb, while both groups performed conventional resistance training of the contralateral limb. Outcomes included lower-limb strength, functional performance (6-minute walk test [6MWT], chair-rising test [CRT]), pain (VAS), and KOOS assessed preoperatively and up to three months postoperatively. Results: Compared with controls, the INT achieved greater preoperative improvements in leg press and extension strength and maintained superior strength at 6 weeks and 3 months postoperatively (p < 0.05). Functional performance was superior, with better CRT and 6MWT performance preoperatively and at 3 months. Additionally, INT showed significantly lower pain values and greater KOOS improvements in Symptoms and Quality of Life before and three months postoperatively in comparison to CON (p < 0.05). Despite higher perceived exertion during exercise sessions, no adverse events occurred. Conclusions: Bilateral prehabilitation combining low-load BFR training of the operative limb with high-load resistance training of the contralateral limb enhanced preoperative muscular and functional reserve, attenuated postoperative decline, and improved early recovery following TKA. Clinical trial registration: https://clinicaltrials.gov/study/NCT06964022 , identifier NCT06964022.