Efficacy of prehabilitation modalities in total knee arthroplasty: A systematic review and network meta-analysis
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Updated: Sep 7, 2026
Clinical Efficacy of Tissue-Bone Homeostasis Manipulation on Soft Tissue Balance and Function in Knee Osteoarthritis
Published on: June 16, 2026
Monique A T van der Vorst1,2, Geeske Peeters1, Gerjon Hannink3
1Department of Geriatrics, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
Objective:
Up to 30% of patients with osteoarthritis experience suboptimal recovery after total knee arthroplasty (TKA), increasing interest in prehabilitation as a potential strategy to improve postoperative outcomes. This study compared the efficacy of individual prehabilitation modalities versus standard care for physical function, quadriceps strength, pain, and health-related quality of life (HR-QoL) at 3 months after TKA, with additional analyses at 4-8 weeks.
Design:
We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) following PRISMA guidelines. Eligible studies included adults undergoing TKA for osteoarthritis who received preoperative prehabilitation targeting physical, educational, nutritional, or behavioral domains. Comparators were standard care or alternative prehabilitation interventions. Confidence in the evidence was assessed using the CINeMA framework.
Results:
20 RCTs (1095 patients) comparing eight prehabilitation modalities were included. At 3 months after TKA, no prehabilitation modality demonstrated statistically significant improvements in physical function, quadriceps strength, pain, or HR-QoL compared with standard care. Similar findings were observed at 4-8 weeks after TKA, except that lower-extremity strength training significantly improved quadriceps strength compared with standard care. Confidence in the evidence was predominantly low to very low, primarily because of imprecision, although three treatment comparisons were supported by moderate confidence.
Conclusion:
Current evidence does not support recommending one prehabilitation modality over another before TKA. Although lower-extremity strength training improved short-term quadriceps strength, this finding was supported by low-confidence evidence. Larger, adequately powered head-to-head trials are needed to determine whether specific prehabilitation modalities provide clinically meaningful postoperative benefits.
Registration:
PROSPERO (CRD42024490615).