Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial

Abstract

Background The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA). Methods 20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients’ Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs. Results No difference between IG and CG was found for SCT (F (2/36) = 0.016, p = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG ( p = 0.002, η2 = 0.536). The sub-item “pain” within the LS presented a higher pain-level in CG (F (18/1) = 4.490, p = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG ( p = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG. Conclusions Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS. Trial registration ClinicalTrials.gov Identifier; NCT03160534 . Registered 19 May 2017

The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials

“…No matter which rehabilitation program can improve the postoperative function of knee surgery, so that patients get the best rehabilitation effect [ 6 ]. Preoperative training was reported as an effective and safe method to improve postoperative functional performance and muscle strength for patients having received TKA [ 7 ]. According to Calatayud et al [ 8 ] high-intensity preoperative supervised training can reduce postoperative pain, improve lower limb muscle strength, range of motion, and shorten the length of hospital stay in patients with TKA.…”

Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? A systematic review

“…Seven studies reported range of movement (Beaupre et al., 2004; Calatayud et al., 2017; Evgeniadis et al., 2008; Gränicher et al., 2020; Huang et al., 2012; Mat Eil Ismail et al., 2016; Matassi et al., 2014).…”

A Systematic Review and Meta-Analysis on Randomized Control Trials for Preoperative Rehabilitation in Patients Planning for Joint Replacement Surgery for Better Outcomes

“…Thus, the policymakers, experimenters, and clinicians are still performing research studies for better ways to enhance the duration of recovery for the patients going through the total joint replacement. The total knee arthroplasty (TKA) is a voluntary surgical approach post the failure of conventional administration among the patients going through the improved knee osteoarthritis (KOA) [ 4 ].…”