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

OBJECTIVE: To evaluate the effects of prehabilitation on post-operative 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 Statement, a systematic search of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL 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 post-operative 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 (i.e., weekly sets, frequency, and load) and the follow-up period (i.e., short term: 1-3-years; mid-term: 5-7-years; and long-term: ≥10 years). RESULTS: Three systematic reviews and 21 meta-analyses (19 THA RCTs, 1,110 THA patients; 46 TKA RCTs, 3,362 TKA patients) ranging from critically low to moderate quality evidence were included. Prehabilitation was favourable 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 six-months. RT volume did not affect post-operative outcomes in two meta-regressions. No analyses evaluated how the manipulation of RT components affected post-operative outcomes. CONCLUSION: Prehabilitation reduced complication rates and improved objective and subjective post-operative outcomes following THA and TKA, with effects generally confined to the first 6 months.