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Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review
Kristin J Konnyu1, Louise M Thoma, Wangnan Cao
1From the Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island (KJK, WC, OAP, MRB, GPA, EMB); Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (LMT); Department of Orthopaedic Surgery, Warren Albert Medical School of Brown University, Providence, Rhode Island (RKA); Orthopedic Program in Clinical/Translational Research, Warren Albert Medical School of Brown University, Providence, Rhode Island (RKA); Miriam Hospital Total Joint Replacement Center, Providence, Rhode Island (RKA); and Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin (DP).
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 performance-based, 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.
