Abstract
This study investigated the comparative effects of a 12-week closed kinetic chain (CKC) versus open kinetic chain (OKC) exercise program on muscle strength, balance, range of motion (ROM), gait, knee function, and pain in elderly women after total knee arthroplasty (TKA). Thirty-six elderly women post-TKA were randomized into three groups: CKC exercise (n = 12), OKC exercise (n = 12), and control (n = 12). The intervention groups followed a structured 12-week exercise regimen. Outcome measures included knee flexion and extension strength, single-leg standing time, Timed Up and Go (TUG) test, six-minute walk test (6MWT), ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS) scores for pain. All groups exhibited significant improvements in knee extension strength over time. The CKC group showed a 122% increase (mean difference = 10.8 Nm; 95% CI, 7.8 to 13.8; p < 0.001), outperforming the OKC (102%) and control groups (97%). ROM and static and dynamic balance improved similarly across groups without significant differences. Gait function, measured by the 6MWT, increased significantly in all groups, with the CKC group demonstrating the greatest gains. No significant differences were observed among groups for pain (VAS) and function (WOMAC) scores. Both CKC and OKC exercise programs effectively enhance lower limb strength, ROM, and balance following TKA in elderly women. However, CKC exercises confer superior benefits in knee extension strength and gait performance, suggesting their preferential use in post-TKA rehabilitation protocols.
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Acknowledgements
The authors wish to acknowledge Corentec, an implant specialist company, for the technical guidance in accurate surgical technique associated with the device. The support did not influence the scientific content, results, or conclusions of this study.
Funding
This work was supported by the Priority Research Centers Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education, Science, and Technology (2017R1A6A1A03015562), and supported by the Ministry of Trade, Industry, and Energy (MOTIE), Korea, under the “Infrastructure program for industrial innovation (reference number P0025775)” supervised by the Korea Institute for Advancement of Technology (KIAT). This work was supported by the Gachon University research fund of 2024 (GCU-202410300001).
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M.H. Kim, K.S. Kong, and K.J. Kim reviewed the clinical data. J.A. Sim conceived the presented idea and reviewed the paper from the clinical aspect. M.H. Kim researched the data and supported the writing of the paper. B.H. Lee oversaw the study and provided the final approval of the overall review and manuscript writing. All authors have read and approved the final manuscript and agreed to its publication.
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The study protocol was approved by Institutional Review Board (IRB) of Gachon University Hospital (IRB No: GDIRB2022-095). This trial was registered in the Clinical Research Information Service (CRiS) (Registration No. KCT0009533) on 14/06/2024.
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Sim, J.A., Kong, KS., Kim, M.H. et al. Comparison of closed and open kinetic chain exercises following total knee arthroplasty in elderly women: a randomized controlled trial. Sci Rep (2026). https://doi.org/10.1038/s41598-026-38892-y
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DOI: https://doi.org/10.1038/s41598-026-38892-y
