The Effects of Prehabilitation and Recovery in Total Knee Arthroplasty Patients: A Systematic Review
Brianna Wynne
Co-Presenters: Connor Platt, Sam Mallari, Kristen Stakemann
College: College of Health Professions and Human Services
Major: DPT.PHYSTHERAPY
Faculty Research Mentor: Bishnoi, Alka Enriquez, Carla
Abstract:
Title: The Effects of Prehabilitation and Recovery in Total Knee Arthroplasty Patients: Systematic ReviewAuthors: Brianna Wynne, SPT, Connor Platt, SPT, Kristen Stakemann, SPT, Sam Mauri Mallari, SPT. Advisor: Alka Bishnoi, PT, PhD.BackgroundPrehabilitation involves structured physical therapy before surgery to optimize postoperative outcomes by improving strength, mobility, and functional readiness.Purpose: To evaluate whether prehabilitation improves postoperative knee strength and range of motion (ROM) in adults undergoing unilateral total knee arthroplasty (TKA) compared with standard care.MethodsPubMed, EBSCOHost, and Journal of Orthopaedic Surgery and Research were searched for studies published January 2014–December 2023. This review followed PRISMA guidelines. Two reviewers independently extracted study design, participant characteristics, intervention parameters, and postoperative outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool and certainty of evidence using GRADE when available. Eligible studies included adults undergoing unilateral TKA who completed structured prehabilitation and reported postoperative strength (dynamometry) and/or ROM (goniometry). Studies were excluded for bilateral TKA, absence of objective outcomes, or non–peer-reviewed designs.ResultsEleven studies met inclusion criteria, including four high-quality randomized controlled trials; however, heterogeneity in intervention protocols, outcome measures, and follow-up periods precluded meta-analysis, and results were synthesized qualitatively. An 8-week preoperative strengthening program improved isometric knee and hip strength and ROM, with benefits maintained up to 3 months postoperatively. Pre- and postoperative progressive resistance training increased dynamic and isometric knee strength in both limbs at 6 weeks. Preoperative strengthening combined with balance training enhanced quadriceps strength preoperatively and sustained advantages at 6 weeks, although long-term balance outcomes were similar. A 4-week home-based online program produced significant preoperative strength gains and maintained improvements in strength and ROM at 3 months compared with usual care.ConclusionPrehabilitation improved early postoperative strength, ROM, and functional performance, though long-term outcomes were comparable to standard care by 6–12 months.Clinical RelevanceThese findings support integrating preoperative training to enhance early functional recovery, preserve muscle performance, and reduce postoperative impairments in patients undergoing TKA. Implementing accessible options, including home-based or virtual programs, may improve feasibility and patient participation while maintaining effectiveness.Suggested Keywords: Prehabilitation, Early Recovery, Total Knee Arthroplasty