Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty

Objective To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty. Methods A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) w...

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Bibliographic Details
Published in:	Arthritis and rheumatism Vol. 55; no. 5; pp. 700 - 708
Main Authors:	Rooks, Daniel S., Huang, Jie, Bierbaum, Benjamin E., Bolus, Sarah A., Rubano, James, Connolly, Christine E., Alpert, Sandra, Iversen, Maura D., Katz, Jeffrey N.
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-10-2006 Lippincott Williams and Wilkins
Subjects:	Aged Arthroplasty, Replacement, Hip Arthroplasty, Replacement, Knee Biological and medical sciences Diseases of the osteoarticular system Exercise Exercise Therapy Health Status Humans Isometric Contraction Male Medical sciences Middle Aged Muscle Contraction Orthopedic surgery Osteoarthritis Osteoarthritis, Hip - physiopathology Osteoarthritis, Hip - surgery Osteoarthritis, Hip - therapy Osteoarthritis, Knee - physiopathology Osteoarthritis, Knee - surgery Osteoarthritis, Knee - therapy Pain - physiopathology Pain - prevention & control Preoperative Care Presurgical Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surveys and Questionnaires Total joint replacement Treatment Outcome Physical exercise Human Total knee arthroplasty Total joint replacement Rheumatology Joint Oshioarthritis Hip Orthopedic surgery Treatment Exercise Prosurgical Preoperative Woman
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Summary:	Objective To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty. Methods A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to a 6‐week exercise or education (control) intervention immediately prior to surgery. We assessed outcomes through questionnaires and performance measures. Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery. Results Among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score (improvement of 2.2 in exercisers versus decline of 3.9 in controls; P = 0.02) and Short Form 36 physical function score (decline of 0.4 in exercisers versus decline of 14.3 in controls; P = 0.003). No significant differences were seen in TKA patients. Exercise participation increased muscle strength preoperatively (18% in THA patients and 20% in TKA patients), whereas the control patients had essentially no change in strength (P > 0.05 for exercise versus education in both THA and TKA groups). Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients (adjusted odds ratio 0.27, 95% confidence interval 0.074–0.998). The intervention had no effects on outcomes 8 and 26 weeks postoperatively. Conclusion A 6‐week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA. Additionally, exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-News-1 ObjectType-Feature-3
ISSN:	0004-3591 0893-7524 1529-0131 1529-0123
DOI:	10.1002/art.22223