Rehabilitation-oriented assessment of functional asymmetry and sensorimotor deficits following total knee arthroplasty: implications for therapeutic strategies in musculoskeletal care

Background Functional asymmetry and sensorimotor control impairments often persist in patients following total knee arthroplasty (TKA), yet they remain under-evaluated in routine clinical settings using simple, scalable tools. Understanding the relationship between these deficits and postoperative outcomes is critical for optimizing rehabilitation strategies. Objectives To assess the prevalence and degree of functional asymmetry in individuals 6–12 months post-TKA using standardized physical therapy assessments, and to evaluate the predictive value of asymmetry and sensorimotor deficits on both functional performance and patient-reported outcomes. Methods A cross-sectional study was conducted on 125 patients aged 55–80 years, 6–12 months after unilateral primary TKA. Functional asymmetry was measured using the Single-Leg Sit-to-Stand (SLSST), Step-Down Test, and modified Star Excursion Balance Test (mSEBT). Functional outcomes included the Timed Up and Go (TUG) and 30-Second Chair Stand Test (30CST). In contrast, self-reported outcomes were assessed he KOOS-ADL and the KOOS–Function in Sport and Recreation (KOOS-Sport/Rec) subscales were administered. Correlations and multiple regression models were used to analyze relationships between asymmetry measures and outcomes. Results Significant correlations were found between asymmetry measures and both functional and self-reported outcomes (e.g., SLSST asymmetry and TUG: r = 0.47, p = 0.005; KOOS-ADL: r = −0.45, p = 0.007). Regression models identified SLSST, Step-Down, and mSEBT asymmetry as significant predictors of TUG (R 2 = 0.48, p < 0.001) and KOOS-ADL (R 2 = 0.53, p < 0.001). Patients with high asymmetry exhibited significantly poorer outcomes across all measures (all p < 0.01). Conclusion Functional asymmetry and sensorimotor deficits are independently associated with poorer mobility and self-reported function post-TKA and can be effectively identified using clinically accessible tools, supporting their integration into routine postoperative assessment and rehabilitation planning.