Comparative Effectiveness of Hydrotherapy vs. Photobiomodulation Therapy (PBMT) for Post Surgical Recovery in Orthopedic Patients Undergoing Total Knee Arthroplasty (TKA)

Abstract

Background: Total knee arthroplasty is an effective intervention for end-stage knee osteoarthritis; however, postoperative pain, limited range of motion, and delayed functional recovery frequently hinder early rehabilitation. Adjunctive nonpharmacological therapies such as hydrotherapy and photobiomodulation therapy have been proposed to enhance postoperative outcomes, yet direct comparative evidence remains limited. Objective: To compare the effectiveness of hydrotherapy and photobiomodulation therapy as adjuncts to standard physiotherapy in improving pain, knee range of motion, functional mobility, and knee-related quality of life following total knee arthroplasty. Methods: In a randomized controlled trial, 90 patients undergoing unilateral primary total knee arthroplasty were allocated to hydrotherapy plus standard physiotherapy (n=30), photobiomodulation therapy plus standard physiotherapy (n=30), or standard physiotherapy alone (n=30). Outcomes included pain intensity measured by the Visual Analogue Scale, knee flexion range of motion, functional mobility assessed using the Timed Up and Go test, and quality of life evaluated with the Knee injury and Osteoarthritis Outcome Score. Assessments were conducted at baseline (postoperative day three), six weeks, and twelve weeks. Repeated measures analysis of variance was used to evaluate group and time effects. Results: Both hydrotherapy and photobiomodulation therapy resulted in significantly greater improvements in pain, knee range of motion, functional mobility, and Knee injury and Osteoarthritis Outcome Score subscales compared with standard physiotherapy alone (p<0.01). Photobiomodulation therapy demonstrated greater early pain reduction at six weeks, whereas hydrotherapy produced larger gains in knee flexion and functional mobility by twelve weeks. Conclusion: Hydrotherapy and photobiomodulation therapy are effective adjuncts to standard rehabilitation after total knee arthroplasty, with distinct recovery profiles. Hydrotherapy preferentially enhances functional outcomes, while photobiomodulation therapy provides earlier pain relief, supporting their potential phase-specific or combined use in postoperative rehabilitation