Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review

Abstract

We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We selected for inclusion randomized controlled trials and adequately adjusted nonrandomized comparative studies of prehabilitation programs reporting performancebased, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. While large heterogeneity across evaluated prehabilitation programs limited strong conclusions, evidence from 13 total knee arthroplasty randomized controlled trials suggest that prehabilitation may result in increased strength and reduced length of stay and may not lead to increased harms but may be comparable in terms of pain, range of motion, and activities of daily living (all low strength of evidence). There was no evidence or insufficient evidence for all other outcomes after total knee arthroplasty. Although there were six total hip arthroplasty randomized controlled trials, there was no evidence or insufficient evidence for all total hip arthroplasty outcomes.

Underweight Body Mass Index Is Associated With Increased In-Hospital Complications and Length of Stay After Revision Total Joint Arthroplasty

“…In addition, although literature has been tepid regarding the widespread implementation of preoperative rehabilitation, future research should be directed toward implementing such interventions specifically in underweight patients, who may be at higher risk for frailty, sarcopenia, and functional limitations. [31][32][33][34] Finally, although the evolving evidence base is currently insufficient to warrant a formal recommendation for an underweight BMI cutoff, the multidisciplinary medical team should consider nutritional counseling and supplementation in this vulnerable and potentially malnourished patient group. There were limitations to this study, many inherent to large database studies.…”

What’s New in Orthopaedic Rehabilitation

“…A systematic review evaluated prehabilitation interventions for elective, unilateral total knee or hip arthroplasty in primary osteoarthritis 20 . Patient-reported health-care utilization and performance outcomes were assessed.…”

Rehabilitation for Total Knee Arthroplasty: A Systematic Review

“…In this article, we address the effects and harms of rehabilitation for patients who underwent TKA on patient-reported outcomes, performance-based outcomes, and healthcare utilization after surgery. In companion articles, we address rehabilitation after THA 13 and prehabilitation before TKA and THA 14 …”