Adherence to total knee arthroplasty guidelines in Saudi physiotherapists

Abstract

Introduction: Total knee arthroplasty (TKA) is a widely performed surgical procedure for managing advanced stages of knee osteoarthritis. Following clinical practice guidelines (CPGs) is essential to ensure optimal rehabilitation outcomes. Objective: To evaluate the level of knowledge and compliance with evidence-based practice guidelines and recommendations related to TKA among physiotherapists in Saudi Arabia. Methods: An online cross-sectional survey was administered among licensed physiotherapists practicing in Saudi Arabia who had managed at least one patient undergoing TKA within the past two years. The questionnaire included demographic questions, two clinical vignettes (prehabilitation and acute postoperative rehabilitation), and statements assessing agreement with evidence-based recommendations (EBR). Adherence levels were categorized, and statistical associations with demographic variables were analyzed using chi-square and ANOVA tests. Results: The study included 391 physiotherapists (mean age: 31.5 ± 6.1 years), with males comprising 78% of the sample. Only 2 and 3% of participants fully adhered to the EBR in the prehabilitation and post-operative vignettes, respectively. Adherence was significantly associated with gender, years of experience, workplace setting, educational level, specialty, and the number of TKA cases managed (p < 0.05). Knowledge gaps were also evident in consensus statements, with less than half agreeing on the use of standardized outcome measures and postoperative management protocols. Conclusion: Adherence to TKA CPGs among Saudi physiotherapists is generally low. Experience, workplace setting, and professional background influence adherence. There is a need for targeted educational interventions and systemic support to improve evidence-based practice in TKA rehabilitation.