Comparison of Closed and Open Kinetic Chain Exercises Following Total Knee Arthroplasty in Elderly Women: A Randomized Controlled Trial

Background/Objectives: This study aimed to investigate the effects of a 12-week closed kinetic chain (CKC) and open kinetic chain (OKC) exercise program on muscle strength, balance, range of motion (ROM), gait, knee function, and pain in elderly women following total knee arthroplasty (TKA). Methods: Thirty-six elderly women post-TKA were randomly assigned to three groups: a CKC exercise group (n=12), an OKC exercise group (n=12), and a control group (n=12). The intervention groups participated in a 12-week structured exercise program. Outcome measures included knee flexion/extension strength, single-leg standing time, Timed Up and Go (TUG), 6-minute walk test (6MWT), ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS) for pain. Results: All groups showed significant improvements over time in knee extension strength, with the CKC group demonstrating the most pronounced gains (p=0.013). ROM and both static and dynamic balance improved in all groups, with no significant differences between them. Gait performance, measured by 6MWT, increased significantly across all groups, with the CKC group showing the greatest improvement throughout the intervention. No significant group differences were observed in VAS and WOMAC scores. Conclusions: Both CKC and OKC exercises are effective in enhancing lower limb strength, ROM, and balance following TKA in elderly women. CKC exercises appear to be particularly beneficial for improving knee extension strength and gait performance.