Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study

Karvannan Harikesavan1, *, Raj D. Chakravarty2, Arun G Maiya3, Sanjay P. Hegde2, Shivakumar Y. Shivanna2
1 Department of Physiotherapy, School of Allied Health sciences, Manipal University, Bangalore. India.
2 Orthopaedic joint replacement surgeon. Manipal Hospital, Bangalore. India.
3 Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, India.

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© 2017 Harikesavan et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Physiotherapy, No 98, Rustum Bagh, Old Airport Road, School of Allied Health Sciences, Manipal University, Bangalore, India; Tel: +91-9986565966; Fax: +91-8202571915; E-mails:,



Total knee replacement (TKR) is the commonest surgical procedure for patients with severe pain and impaired physical function following end stage knee osteoarthritis. The hip abductors are well renowned in stabilization of the trunk and hip during walking, maintaining the lower limb position, and transferring the forces from the lower limbs to the pelvis.


To assess the efficacy of hip abductor strengthening exercise on functional outcome using performance based outcome measures following total knee replacement.


An observer blinded randomized pilot trial design was conducted at Manipal hospital, Bangalore, India. Participants designated for elective TKR were randomized to experimental group hip abductor strengthening along with standard rehabilitation (n=10) or control group standard rehabilitation alone (n=10). Participants followed for one year to assess physical function using performance based outcomes, such as timed up and go test, single leg stance test, six minute walk test, knee extensor strength and hip abductor strength.


Eighteen participants with a mean age of 63.1 ± 5.5 years (8 Males and 10 Females) completed the study. Improvement in hip abduction strength, single leg stand test was superior in hip abductor strengthening group at 3 months and 1 year when compared to standard rehabilitation alone.


Hip abductor strengthening showed superior improvements in single leg stance test and six minute walk test. Hip abductor strengthening exercises has the potential to improve physical function following total knee replacement.

Keywords: Total knee replacement, Hip abductor strengthening, Knee exercises, Single leg stance, Osteoarthritis.