Neuromuscular electrical stimulation for pre- and post-knee replacement surgery: a qualitative study

Total knee replacement effectively relieves pain and restores function in end-stage osteoarthritis, but rehabilitation is essential to optimize outcomes. Postoperative pain, quadriceps weakness, and limited mobility can restrict participation in conventional exercises. Neuromuscular electrical stimulation (NMES) may support muscle activation when voluntary exercise is difficult, yet its use in practice remains limited. This qualitative study explored perspectives of patients and healthcare professionals on NMES use in pre- and postoperative knee rehabilitation. Twelve participants, including seven patients with knee osteoarthritis and five clinicians, were interviewed using semi-structured interviews. Data were analyzed using reflexive thematic analysis. Participants reported benefits, including improved pain management and enhanced muscle activation, particularly when exercise was not feasible. Barriers included limited familiarity, device complexity and usability, cost, availability, and integration challenges within routine care. Our findings highlight the need for improved device design, better clinical training, and greater awareness. User-informed development may improve alignment with clinical needs and patient preferences in knee rehabilitation. These insights suggest that addressing educational gaps and simplifying device interfaces could enhance clinician confidence and patient engagement. Wider implementation may improve recovery experiences and functional outcomes following knee replacement surgery while supporting more equitable and efficient healthcare by enabling home-based rehabilitation.