PurposeTelehealth rehabilitation (telerehab) is an increasingly popular cost‐saving alternative to traditional rehabilitation after total joint arthroplasty. We compared the safety and efficacy of an institutional telerehab program to conventional “face‐to‐face” rehabilitation in a sample of patients undergoing total knee arthroplasty (TKA). MethodsA retrospective matched cohort study was performed. Medicare patients who utilized telerehab following unilateral TKA were matched in a 1:3 ratio to those utilizing conventional rehabilitation. Patients were matched on sex, body mass index (BMI, ± 5 kg/m2), preoperative extension (± 10 degrees), preoperative flexion (± 10 degrees), and Risk Assessment and Prediction Tool (RAPT) score (± 2 points). Ninety‐day unplanned healthcare encounters, 120‐day manipulations under anesthesia (MUAs), and 6‐week and 3‐month changes in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS‐JR), pain visual analog scale (VAS), Veterans RAND 12 (VR‐12), and Lower‐Extremity Activity Scale (LEAS) were compared between groups. ResultsEighty‐two telerehab patients and 244 conventional rehab patients were included. After matching, there were no differences in 90‐day unplanned healthcare encounters or 120‐day MUA rates between groups. There were no differences in 6‐week or 3‐month changes in KOOS‐JR, VAS pain, or VR‐12 mental or physical sub‐scores between groups. Telerehab patients had a greater improvement in LEAS score at 3 months compared to the conventional group (mean difference 1.9, P = 0.03). ConclusionIn a matched cohort study of 326 TKA patients, telerehab patients had similar rates of unplanned healthcare encounters and MUAs and similar patient‐reported outcomes compared to conventional PT patients, suggesting that telerehab can be an equally effective alternative to conventional PT following TKA. Level of evidenceIII