Missed opportunities in post-total knee arthroplasty rehabilitation in Indonesia: a narrative review of insurance-driven delays in functional recovery

Abstract

Total knee arthroplasty (TKA) is increasingly performed worldwide, including in Southeast Asia and Indonesia, and early-phase rehabilitation is a primary determinant of postoperative functional recovery; delays during this critical window can impair strength, mobility, independence, and long-term quality of life. This narrative review examines the gap between internationally established evidence-based rehabilitation protocols and current practices in Indonesia and describes the impact of insurance-related delays on functional outcomes. Global literature consistently supports early mobilization, intensive therapeutic exercise, multidisciplinary care, and standardized outcome monitoring, whereas rehabilitation in Indonesia is often constrained by short hospital stays, uneven distribution of rehabilitation professionals, the absence of national protocols, and, most critically, limited BPJS insurance coverage. These constraints create missed opportunities during the first 1-2 postoperative weeks, contributing to stiffness, muscle weakness, abnormal gait, delayed daily function, and lower patient satisfaction, while systemically increasing long-term care needs, caregiver burden, and indirect healthcare costs. Because functional recovery after TKA is highly dependent on timely, intensive early rehabilitation, administrative and insurance-related barriers in Indonesia produce clinically meaningful delays and long-term dependency. By mapping these systemic gaps and their consequences, this review aims both to inform future policy refinement and to raise awareness among policymakers, clinicians, and stakeholders regarding the urgent need to optimize early rehabilitation to improve outcomes and strengthen healthcare system efficiency.

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