Prehabilitation Improves Knee Functioning before and within the First Year after Total Knee Arthroplasty: A Systematic Review with Meta-Analysis

OBJECTIVE: To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surger DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Database search of MEDLINE/PubMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus until March 2022. STUDY SELECTION CITERIA: Peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation. DATA SYNTHESIS: We assessed bias using the Cochrane Risk of Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardised mean differences (Hedges' g) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the GRADE approach. RESULTS: Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low- to very low-certainty evidence favoured prehabilitation over no intervention for improving knee functioning before (g = 1.23; 95% CI: 0.49, 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month, g = 0.90; 95% CI: 0.18, 1.61; mid-term: 6 weeks to 3 months, g = 0.45; 95% CI: 0.06, 0.84). There were no significant between-group differences at long-term follow-up (6-12 months, g = 0.07; 95% CI: -0.17, 0.30). CONCLUSION: There was low- to very low-certainty evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive.