Preoperative lifestyle modifications combined with a structured exercise protocol on patient outcomes following total knee replacement surgery: A systematic review

Abstract

BackgroundMedical guidelines recommend structured prehabilitation protocols consisting of lifestyle modifications and exercise to enhance post‐operative outcomes for patients undergoing a total knee replacement (TKR). However, current research showing effectiveness is limited and has primarily focused on outcomes of exercise‐based prehabilitation.ObjectivesTo investigate whether a structured prehabilitation protocol consisting of exercise and lifestyle modifications improves physical function and patient‐reported outcomes following TKR surgery compared with usual care.DesignSystematic review.MethodsFive databases were searched to identify randomised controlled trials comparing structured prehabilitation programs consisting of lifestyle modifications and exercise, with usual care, for those undergoing a TKR. Methodological quality of included studies was assessed via the RoB 2.0 tool and results synthesis via a Grading of Recommendation Assessment, Development and Evaluation approach was performed to determine the certainty evidence for each outcome.Results/findingsFour studies were included in this review. Despite a positive trend supporting the inclusion of a structured prehabilitation protocol, additional improvements in post‐operative pain, physical function and self‐reported function were only seen in one study. Reductions in hospital length of stay were also seen in one study. No additional improvements in post‐operative quality of life following prehabilitation were reported.ConclusionLimited evidence supporting prehabilitation reported in our review is likely attributed to the intervention type, intensity, and delivery model of included studies. However, there remains to be strong evidence supporting the use of a structured prehabilitation protocol consisting of lifestyle modifications and exercise to improve post‐operative outcome.