Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Peer, Maria A; Rush, Robert; Gallacher, Peter; Gleeson, Nigel

doi:10.2340/16501977-2210

Cited by 27 publications

(33 citation statements)

References 76 publications

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“…Conversely, length of stay was comparable between groups, although only one study reported these data. As in previous review works, these results do not achieve clinical relevance, although most are statistically significant [23,24].…”

Section: Main Interventioncontrasting

confidence: 42%

The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review

Vasta

Papalia

Torre

et al. 2020

JCM

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Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent two of the most common procedures in orthopedic surgery. The growing need to avoid physical impairment in elderly patients undergoing this kind of surgery puts the focus on the possibility to undertake a preoperative physical activity program to improve their fit and physical health at the time of surgery. A systematic review has been carried out with online databases including PubMed-Medline, Cochrane Central and Google Scholar. The aim was to retrieve available evidence concerning preoperative physical activity and exercise, before total knee or total hip arthroplasty in patients older than 65 years, and to clarify the role of this practice in improving postoperative outcomes. Results of the present systematic analysis showed that, for TKA, most of the studies demonstrated a comparable trend of postoperative improvement of Visual Analogue Scale (VAS), range of movement (ROM) and functional scores, and those of quality of life. There is insufficient evidence in the literature to draw final conclusions on the topic. Prehabilitation for patients undergoing TKA leads to shorter length of stay but not to an enhanced postoperative recovery. Concerning THA, although currently available data showed better outcomes in patients who underwent prehabilitation programs, there is a lack of robust evidence with appropriate methodology.

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Section: Main Interventioncontrasting

confidence: 42%

The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review

Vasta

Papalia

Torre

et al. 2020

JCM

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“…Pre‐operative rehabilitation interventions (or “prehabilitation”) for the purposes of improving post‐operative recovery have received considerable interest. Our search identified nine systematic reviews including 14 randomised trials. Interventions included a heterogeneous group of exercise programs, including physiotherapist supervised and unsupervised exercise, coupled with co‐interventions including acupuncture, kinesiology and education .…”

Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

“…Interventions included a heterogeneous group of exercise programs, including physiotherapist supervised and unsupervised exercise, coupled with co‐interventions including acupuncture, kinesiology and education . While two reviews found marginal benefits to length of stay and knee range of motion, and one review demonstrated a dose–response benefit to several physical outcome measures, there was little benefit when a GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the evidence was performed . Twelve of 14 trials were found to have a high risk of bias, and only small, short term benefits were found for pain (100‐point scale mean difference, − 6.1; 95% CI, − 10.6 to − 1.6) and patient‐reported function (mean difference, 4.0; 95% CI, 7.5–0.5).…”

Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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“…Previous reviews have focused on outcomes relating to preoperative function and pain, the in-hospital experience and long-term recovery 10 12–46. Review conclusions vary based on the outcomes and follow-up times.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic literature search of MEDLINE, Embase, PsycINFO, CINAHL and The Cochrane Library on 18 December 2018, we identified 36 systematic reviews of preoperative interventions in TKR. Twenty-five of these had searches conducted more than 5 years previously,10 12–35 and nine exclusively reported short-term outcomes (3 months or less after surgery) 36–44. Two more recent reviews considered the outcome of long-term pain45 46 but neither had a registered protocol.…”

Section: Introductionmentioning

confidence: 99%

Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

et al. 2020

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ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

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Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Abstract: Despite a potential for efficacy of exercise-based conditioning, this review highlights the scarcity of robust dose-response evidence to guide the formulation of total knee arthroplasty prehabilitation effectively.

Cited by 27 publications

References 76 publications

The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review

The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review

Selecting and optimising patients for total knee arthroplasty

Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

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