The effectiveness of resistance training for patients with degenerative arthritis after total joint arthroplasty: a pilot randomized controlled study

Abstract

This study aimed to examine the effects of a volume-progressive staged bilateral resistance training program on lower limb muscular endurance, balance performance, pain intensity, and quality of life among patients with osteoarthritis following total joint arthroplasty (total knee and hip arthroplasty). Conventional post-arthroplasty rehabilitation predominantly focuses on early localized, unweighted mobilization restricted to the surgical limb. However, severe acute pain and joint trauma often preclude early progressive loading, leading to persistent cross-limb deficits. A knowledge gap remains regarding whether a hospital-initiated, staged bilateral resistance program—starting with non-operated limb conditioning to leverage cross-limb adaptations before progressive bilateral loading—can safely enhance early functional recovery. A pilot randomized controlled study. Twenty-four patients undergoing unilateral total joint arthroplasty (TKA/THA) were recruited and randomly assigned to either the experimental group ( n = 12, 3-month staged bilateral resistance training) or the control group ( n = 12, routine rehabilitation). Outcomes measured at baseline (T0), hospital discharge (T1), 1 month (T2), and 3 months postoperatively (T3) included lower extremity muscular endurance (30-second chair stand), dynamic balance (2.44-m TUG), pain intensity (VAS), and quality of life (WHOQOL-BREF). Statistical analyses utilized GEE and ANCOVA (α = 0.05). All 24 participants completed the 3-month follow-up. Generalized Estimating Equation analyses revealed that the experimental group achieved significantly greater improvements in lower extremity muscular endurance at T2 ( p = .004) and T3 ( p < .001) compared with controls. For dynamic balance, ANCOVA after baseline adjustment demonstrated that the experimental group achieved significantly greater performance improvements across all postoperative time points (T1: p = .037; T2: p = .001; T3: p < .001). At 3 months, the experimental group also reported significantly lower pain intensity ( p = .023). Quality of life improved over time in both groups, but the between-group difference was not statistically significant ( p = .062). Hospital-initiated staged bilateral resistance training appears feasible and safe following total joint arthroplasty, demonstrating preliminary benefits for lower limb muscular endurance, dynamic balance, and pain reduction. Quality of life improved in both groups over time without significant group differences, indicating a non-significant numerical trend. Larger prospectively registered trials are required to confirm these preliminary findings. ClinicalTrials.gov NCT07696195, Registered July 8, 2026 (Retrospectively registered).