The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty

The purpose of this study was to examine the effect of a preoperative exercise intervention on knee pain, functional ability, and quadriceps strength among patients with knee osteoarthritis before and after total knee arthroplasty (TKA) surgery.

A repeated-measures design was used to compare 2 groups over 4 data collection points.

Community-dwelling subjects with osteoarthritis of the knee who were scheduled for a unilateral TKA were recruited from a single orthopedic surgeon's office and were randomized into control (n = 28) or prehab groups (n = 26).

The control patients maintained usual care before their TKA. The exercisers performed prehabilitation exercises, which included resistance training, flexibility, and step training, 3 times per week before their TKA.

Knee pain, functional ability, quadriceps strength, and strength asymmetry were assessed at baseline (T1), at 1 week before the patients' TKA (T2), and again at 1 (T3) and 3 (T4) months after TKA.

The exercisers improved their sit-to-stand performance at T2, whereas the control group did not change their performance of functional tasks and had increased pain at T2. At T3 the exercisers demonstrated improved sit-to-stand performance. The control patients at T3 exhibited decreases in pain, their 6-minute walk, surgical leg strength and an increase in their nonsurgical leg strength and leg strength asymmetry. At T4 the exercisers improved in their performance of 3 of the 4 functional tasks, decreased all of their pain measures, and increased their surgical and nonsurgical quadriceps strength. At T4 the control group improved their performance on 2 of the 4 functional tasks, decreased all of their pain measures, increased their nonsurgical leg strength, and exhibited greater leg strength asymmetry.

These findings appear to indicate the efficacy of prehabilitation among TKA patients and support the theory of prehabilitation.