The Effects of Structured Prehabilitation on Postoperative Outcomes Following Total Hip and Total Knee Arthroplasty: An Overview of Systematic Reviews and Meta-analyses of Randomized Controlled Trials

Abstract

OBJECTIVE: To evaluate the effects of prehabilitation on postoperative outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). DESIGN: Overview of systematic reviews and meta-analyses of randomized controlled trials. LITERATURE SEARCH: Guided by the PRIOR (Preferred Reporting Items for Overviews of Reviews) statement, a systematic search of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL (Cochrane Register of Controlled Trials) was conducted using the following overarching topics: hip, knee, arthroplasty, and prehabilitation. STUDY SELECTION CRITERIA: Systematic reviews, meta-analyses, or meta-regressions of randomized controlled trials that investigated how postoperative outcomes differed between patients who underwent primary THA or TKA and engaged in a structured prehabilitation program (exclusively resistance training [RT]-focused or multimodal with RT) or non-RT exercising controls. DATA SYNTHESIS: THA and TKA data were analyzed separately, with results delineated based on RT components (ie, weekly sets, frequency, and load) and the follow-up period (ie, short term: 1-3 years; midterm: 5-7 years; and long term: ≥10 years). RESULTS: Three systematic reviews and 21 meta-analyses (19 THA randomized controlled trials, 1110 THA patients; 46 TKA randomized controlled trials, 3362 TKA patients) ranging from critically low- to moderate-quality evidence were included. Prehabilitation was favorable for reducing the rate of complications, improving strength, objective function, quality of life, and self-reported function in patients undergoing THA and TKA. Effects were attenuated over time and were generally confined to the first 6 months. RT volume did not affect postoperative outcomes in 2 meta-regressions. No analyses evaluated how the manipulation of RT components affected postoperative outcomes. CONCLUSION: Prehabilitation reduced complication rates and improved objective and subjective postoperative outcomes following THA and TKA, with effects generally confined to the first 6 months. J Orthop Sports Phys Ther 2025;55(5):1-22. Epub 3 April 2025. doi:10.2519/jospt.2025.13075.

Keywords: exercise intervention; joint replacement; preoperative exercise; strength training.