Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review With Meta-analysis

• Published in: The journal of orthopaedic and sports physical therapy Vol. 52; no. 11; pp. 709 - 725
• Main Authors: Gränicher, Pascale, Mulder, Loes, Lenssen, Ton, Scherr, Johannes, Swanenburg, Jaap, de Bie, Rob
• Format: Journal Article
• Language: English
• Published: United States 01-11-2022
• Subjects: Arthroplasty, Replacement, Knee - rehabilitation; Humans; Knee; Knee Joint - surgery; Osteoarthritis, Knee - rehabilitation; Osteoarthritis, Knee - surgery; Preoperative Exercise; systematic review/meta-analysis; total knee arthroplasty; physical therapy; exercise therapy; preoperative exercise; knee joint
• ISSN: 0190-6011; 1938-1344
• DOI: 10.2519/jospt.2022.11160

To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surgery.
Intervention systematic review with meta-analysis.
The authors searched the MEDLINE/PubMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science, and Scopus databases from their inception until March 2022.
The authors included peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation.
We assessed bias using the Cochrane Risk-of-Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardized mean differences (Hedges'
) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low to very low certainty of evidence favored prehabilitation over no intervention for improving knee functioning before (
= 1.23; 95% CI: 0.49, 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month,
= 0.90; 95% CI: 0.18, 1.61; mid-term: 6 weeks to 3 months,
= 0.45; 95% CI: 0.06, 0.84). There were no significant between-group differences at long-term follow-up (6-12 months,
= 0.07; 95% CI: -0.17, 0.30).
There was low to very low certainty of evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive.
.