Effects of home-based prehabilitation on pre and postoperative outcomes following total hip and knee arthroplasty: a systematic review and meta-analysis

De Klerk, Talitha C.; Dounavi, Despoina M.; Hamilton, David F.; Clement, Nick D.; Kaliarntas, Konstanotnos T.

Abstract

Aims
The aim of this study was to determine the effectiveness of home-based prehabilitation on pre and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA).

Methods
A systematic review with meta-analysis of randomised controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, Pubmed, Cochrane Library and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool.

Results
Twenty-two RCTs (1601 participants) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD) -1.02: p = 0.00), with non-significant improvements for function before (MD -0.48; p = 0.06) and after TKA (MD -0.69, p = 0.25). Small preoperative improvements were observed for pain (MD -0.02; p = 0.87) and function (MD-0.18; p = 0.16) prior to THA but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p= 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD -0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD -0.43 days; p < 0.00) but not for THA (MD, -0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5%.

Conclusions
Prehabilitation interventions improve pain and function prior TKA and THA, and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively.

• Journal Article Type: Review
• Acceptance Date: Feb 28, 2023
• Online Publication Date: May 5, 2023
• Publication Date: 2023
• Deposit Date: May 1, 2023
• Publicly Available Date: May 1, 2023
• Journal: Bone & Joint Open
• Publisher: British Editorial Society of Bone and Joint Surgery
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 5
• Pages: 315-328
• DOI: https://doi.org/10.1302/2633-1462.45.BJO-2023-0021