DOI: https://doi.org/10.14710/dmj.v15i6.55462

THE RANGE OF MOTION OUTCOME AFTER HYBRID ASSISTED LIMBS REHABILITATION ON END-STAGE OSTEOARTHRITIS PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW AND META ANALYSIS

Putri Dewita Sari  -  Department of Physical Medicine and Rehabilitation, Faculty of Medicine Diponegoro University, Semarang, Indonesia, Indonesia
Rudy Handoyo  -  Department of Physical Medicine and Rehabilitation, Faculty of Medicine Diponegoro University, Semarang, Indonesia, Indonesia
*Tanti Ajoe Kesoema  -  Department of Physical Medicine and Rehabilitation, Faculty of Medicine Diponegoro University, Semarang, Indonesia , Indonesia
Open Access Copyright 2026 Putri Dewita Sari, Rudy Handoyo, Tanti Ajoe Kesoema
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Abstract

Background: Total knee arthroplasty (TKA) effectively treats advanced knee osteoarthritis by reducing pain and restoring function, though limited postoperative range of motion (ROM) remains a challenge. Innovations like the Hybrid Assistive Limb (HAL) offer robotic support to enhance neuromuscular activation and movement precision during recovery. Objective: The objective of this research was to carefully assess and quantitatively aggregate the current data about the impact of HAL rehabilitation on knee flexion range of motion (both active and passive) in patients receiving total knee arthroplasty for end-stage osteoarthritis.Methods: A systematic review and meta-analysis were performed in accordance with PRISMA recommendations.  A thorough literature search was conducted using PubMed, Cochrane Library, and ScienceDirect. Studies included if they involved TKA patients undergoing HAL rehabilitation with reported outcomes in active or passive knee flexion. Mean differences with 95% confidence intervals (CI) were aggregated using a random-effects model, and I² assessed heterogeneity. Results:  Eight studies with 306 participants met the criteria. A meta-analysis showed a significant mean difference of 13.01° in active ROM during flexion, favoring the HAL group (95% CI: 10.26–15.77; p < 0.00001; I² = 0%).  In passive ROM during flexion, five investigations indicated a mean difference of 5.51° in favor of HAL (95% CI: 2.75–8.26; p < 0.0001; I² = 0%).  Both results showed low heterogeneity, indicating consistent results across studies. Conclusion: HAL rehabilitation significantly enhances both active and passive ROM following TKA. Future research should explore long-term outcomes, economic feasibility, and applicability across broader patient populations.

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Keywords: Hybrid Assisted Limbs; Meta-analysis; Osteoarthritis; Total Knee Arthroplasty

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