Fifty patients with knee osteoarthritis undergoing total knee arthroplasty were randomized to receive either early postoperative extracorporeal shock wave therapy combined with physiotherapy (n=25) or physiotherapy alone (n=25). The primary outcome was active knee range of motion (aROM). Secondary outcomes included the Timed Up and Go (TUG) test, Visual Analog Scale (VAS) for pain, and the Borg scale. Outcomes were assessed at baseline, day two, and day seven postoperatively, with an additional 30-day follow-up for quality of life via SF-36. Overall, the study revealed that the group receiving ESWT in addition to physiotherapy had significantly better improvements in aROM, TUG, VAS, and Borg scale at seven days compared to physiotherapy alone. The early application of ESWT appears to be a safe and effective adjunct for improved pain relief and functional recovery in TKA patients.