Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review.

ABSTRACT: We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral TKA or THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005 through May 3, 2021. We selected for inclusion randomized controlled trials and adequately-adjusted nonrandomized comparative studies of prehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence (SoE). While large heterogeneity across evaluated prehabilitation programs limited strong conclusions, evidence from 13 TKA RCTs suggest prehabilitation may result in increased strength and reduced length of stay and may not lead to increased harms, but may be comparable in terms of pain, range of motion and activities of daily living (all low SoE). There was no evidence or insufficient evidence for all other outcomes following TKA. Although there were 6 THA RCTs, there was no evidence or insufficient evidence for all THA outcomes.