Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

To quantify the effectiveness of prehabilitation prior to total knee and hip arthroplasty (TKA/THA) for osteoarthritis on postoperative outcomes assessed by self-report and performance-based measures.

Methods

Embase, MEDLINE, CENTRAL, CINAHL and Scopus (inception-August 2022) were searched for randomized controlled trials. Self-report outcomes were function, health-related quality of life (HRQoL), and pain. Performance-based outcomes were strength, range of motion (ROM), balance, and functional mobility. The RoB 2.0 assessed risk of bias. Random-effects meta-analysis was performed up to 52 weeks after TKA/THA.

Results

High risk of bias was found in 24 of 28 trials. Prehabilitation improved function (SMD = 0.50 [95%CI: 0.23, 0.77]), pain (SMD = 0.44 [95%CI: 0.17, 0.71]), HRQoL (SMD = 0.28 [95%CI: 0.12, 0.43]), strength (SMD = 0.72 [95%CI: 0.47, 0.98]), ROM (SMD = 0.31 [95%CI: 0.02, 0.59]), and functional mobility (SMD = 0.39 [95%CI: 0.05, 0.73]) post-TKA. No significant effect of prehabilitation on balance (SMD = 0.28 [95%CI: −0.11, 0.66]) post-TKA. All outcomes assessed had significant heterogeneity (p < 0.01). There were limited and contradictory trials (n = 2) for THA.

Conclusion

High risk of bias and significant heterogeneity observed in our meta-analysis prevent conclusions regarding prehabilitation effectiveness on outcomes up to one year after TKA/THA.

IMPLICATIONS FOR REHABILITATION

• Prehabilitation has been promoted to improve postoperative outcomes and shorten recovery periods after total knee/hip arthroplasty (TKA/THA) for osteoarthritis

• Prehabilitation improved relevant self-report and performance-based outcomes after TKA surgery

• A high risk of bias and significant heterogeneity across trials prevent drawing any conclusions

• More high-quality research is required before recommending the implementation of prehabilitation programs in clinical practice for people awaiting TKA/THA

Keywords:

• Osteoarthritis
• prehabilitation
• randomized controlled trials
• systematic review
• total knee and hip arthroplasty

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Canadian Musculoskeletal Rehab Research Network [CIHR FRN: CFI-148081]. The funding agency had no role in the design of the study, data collection, analysis, interpretation of data or in writing the manuscript.