Maximum recovery after knee replacement (MARKER) study. A large multicentre randomised clinical trial comparing short and long-term outcomes between a novel intensive class-based exercise regimen and usual practice.


An excellent opportunity exists for a physiotherapist to conduct research in outcomes after total knee replacement surgery.

The MARKER study is a multicentre controlled clinical trial that will randomize about 600 people who have recently undergone primary total knee replacement surgery to a novel intensive exercise program or usual rehabilitative care. The study is funded and is able to employ a suitable candidate part time. Recruitment has commenced at two of the ten large hospitals that have confirmed study collaboration.


Associate Professor Marlene Fransen

Research Location

Clinical and Rehabilitation Sciences Research Group

Program Type



There is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the demonstrated lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the MARKER study is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by outpatient exercise classes.

In this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR surgery, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided or recommended by the orthopaedic surgeon or hospital. Outcomes assessments will be conducted at baseline (pre-TKR surgery) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community costs, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery.The results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.

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osteoarthritis, knee, joint replacement surgery, Physiotherapy, Rehabilitation, exercise.

Opportunity ID

The opportunity ID for this research opportunity is: 1006

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