A Systematic Review and Meta-Analysis on Randomized Control Trials for Preoperative Rehabilitation in Patients Planning for Joint Replacement Surgery for Better Outcomes

Abstract

Background. The clinical influence of the preoperative and postoperative therapies for recovery after the joint replacement surgery is still questionable. This study of systematic review and meta-analysis focuses on analyzing the clinical effects of preoperative rehabilitation among the patients who are planning to opt for joint replacement surgery for enhanced results. Objective. Randomized clinical trials were selected where preoperative therapeutic exercises were performed by adults for preoperative rehabilitation in patients who were planning for replacement surgery for better outcomes and identified through databases and screening. Two reviewers were responsible for extracting appropriate studies, relevant data, assessing the risks, therapeutic validity, etc. Material and Methods. We performed random-effects meta-analysis for calculation of risk ratios and odds ratios, for knee and hip surgery cases. Analysis of length of hospital stay, short-term-based recovery period during hospital stay, total hip replacement functional recovery during hospital stay, short-term recovery of self-reported functioning, etc. was performed. Results. Functional scores, postoperative pain, recovery time, length of hospital stay, and quality of life were studied. Of the seven studies included, the data of 614 patients were studied. The total number of participants in both exercise and control groups was analyzed to assess the bias of the study where the risk ratio was 0.96 and (0.74–1.25) was the 95% CI. Short-term-based recovery period during hospital stay for knee replacement was analyzed where 0.87 was the risk ratio and (0.61–1.23) was the 95% CI and for hip replacement where 0.99 was the risk ratio and (0.68–1.44) was the 95% CI. The RR for total hip replacement functional recovery during hospital stay was 0.80 with 95% CI (0.54–1.19). The RR for short-term recovery of self-reported functioning was 0.98 with 95% CI (0.76–1.26). Outcome analysis for pain and functionality evaluation was performed and assessed using WOMAC, HOOS, and HHS scores where the standardized mean difference was 0.38 and (0.20–0.57) was the 95% CI in hip surgery pain analysis and in knee surgery, 0.00 was the standardized mean difference and (−0.18–0.19) was the 95% CI. Conclusion. Long-term outcomes were not affected by the preoperative rehabilitation. Though there was a slight improvement in early postoperative pain, this is not much of clinical significance.

Effects of home-based prehabilitation on pre- and postoperative outcomes following total hip and knee arthroplasty

“…The effectiveness of prehabilitation to improve outcomes following THA and TKA has been examined by several systematic reviews with varying conclusions. [22][23][24][25][26][27][28][29][30] Most reviews assess only postoperative outcomes, which may be affected by surgery quality, postoperative complications, pain, mismatch of expectations, and motivation to return to rehabilitation. 31 Prehabilitation varies substantially in content and is currently predominantly home-based.…”

“…Previous reviews have studied the effect of prehabilitation on postoperative pain, function, and hospital LOS. 22,24,25,[28][29][30] However, we evaluated the effectiveness of prehabilitation prior to TKA and THA in addition to outcomes following surgery to account for factors associated with surgical success, complications, and recovery. The included studies in this review had reasonably good methodological quality (6/10 PEDro scores).…”

Patients’ needs and experiences of telerehabilitation after total hip and knee arthroplasty: A qualitative systematic review and meta-synthesis

“…Arthroplasty serves as an effective therapeutic approach for managing end-stage joint pathology and restoring joint functionality, thereby offering noteworthy pain relief and ameliorating the physical function and overall quality of life for patients. 1 , 2 Both total hip arthroplasty (THA) and total knee arthroplasty (TKA) have exhibited remarkable success rates and cost-effectiveness as joint replacement procedures. 3 , 4 In recent years, there has been a progressive increase in the number of patients undergoing THA and TKA, which is attributed to the global population aging and advancements in artificial joint replacement technology.…”

Effects of tele-prehabilitation on clinical and muscular recovery in patients awaiting knee replacement: protocol of a randomised controlled trial

“…A recent systematic review and meta-analysis10 investigating the effects of prehabilitation before orthopaedic surgery, results in a higher improvement of preoperative function and health-related quality of life among patients undergoing all investigated procedures (TKA, THA, lumbar surgery), with moderate to low certainty of evidence 10. However, the existing evidences on its effectiveness on postoperative outcomes remains controversial, especially for long-term outcomes 11–13. It is well known that disuse and inactivity, occurring during illness and hospitalisation, result in rapid muscle atrophy and decreased muscle protein synthesis.…”