Preoperative Strength Training for Clinical Outcomes Before and After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Abstract

BackgroundThere is an increasing interest in preoperative strength training for promoting post-operative rehabilitation, but the effectiveness of preoperative strength training for clinical outcomes after total knee arthroplasty (TKA) remains controversial.ObjectiveThis study aims to systematically evaluate the effect of preoperative strength training on clinical outcomes before and after TKA.MethodsWe systematically searched PubMed, Cochrane Library, Web of Science, and EMBASE databases from the inception to November 17, 2021. The meta-analysis was performed to evaluate the effects of preoperative strength training on clinical outcomes before and after TKA.ResultsSeven randomized controlled trials (RCTs) were included (n = 306). Immediately before TKA, the pooled results showed significant improvements in pain, knee function, functional ability, stiffness, and physical function in the strength training group compared with the control group, but not in strength (quadriceps), ROM, and WOMAC (total). Compared with the control group, the results indicated strength training had a statistically significant improvement in post-operative knee function, ROM, and functional ability at less than 1 month and 3 months, and had a statistically significant improvement in post-operative strength (quadriceps), stiffness, and WOMAC (total) at 3 months, and had a statistically significant improvement in post-operative pain at 6 months. However, the results indicated strength training had no statistically significant improvement in post-operative strength (quadriceps) at less than 1 month, 6, and 12 months, had no statistically significant improvement in post-operative pain at less than 1 month, 3, and 12 months, had no statistically significant improvement in post-operative knee function at 6 and 12 months, and had no statistically significant improvement in post-operative physical function at 3 months.ConclusionsPreoperative strength training may be beneficial to early rehabilitation after TKA, but the long-term efficacy needs to be further determined. At the same time, more caution should be exercised when interpreting the clinical efficacy of preoperative strength training for TKA.

Preoperative high-intensity strength training combined with balance training can improve early outcomes after total knee arthroplasty

“…The handrail could be held if needed [ 19 ]. The total duration of this test was measured and averaged with a stopwatch, which stopped when the patient reached the starting line after going up and down the stairs [ 20 ]. The test was performed twice with a 30-s rest period.…”

Supporting patients to prepare for total knee replacement: Evidence‐, theory‐ and person‐based development of a ‘Virtual Knee School’ digital intervention

“…Pre‐operative TKR education is particularly important for setting realistic expectations and supporting patients to actively engage in their care 9,10 . There is also growing evidence that prehabilitation (health/wellbeing optimisation) interventions may improve patient outcomes pre‐ and post‐TKR 11–13 . Despite this, current United Kingdom (UK) National Health Service (NHS) pre‐operative TKR intervention provision is variable, inefficient and often inadequate 14,15 .…”

“… 9 , 10 There is also growing evidence that prehabilitation (health/wellbeing optimisation) interventions may improve patient outcomes pre‐ and post‐TKR. 11 , 12 , 13 Despite this, current United Kingdom (UK) National Health Service (NHS) pre‐operative TKR intervention provision is variable, inefficient and often inadequate. 14 , 15 When provided, pre‐operative TKR support has traditionally been delivered via face‐to‐face group classes, often called ‘knee schools’.…”