Does pre-operative physical therapy improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty? A systematic review

Abstract

Background and purpose: Pre-operative physical therapy (PT) has been used in clinical practice to improve post- surgical outcomes after a total hip and/or knee replacement. The purpose of this systematic literature review was to investigate the ability of pre-operative physical therapy to improve post-surgical outcomes of patients undergoing a total knee and/or total hip arthroplasty. Methods: This review used the search engines PubMed, CINAHL, Cochrane library and the PEDro database and investigated all articles that studied the influence of pre-operative therapy on post-surgical results in patients that underwent a total knee and/or total hip arthroplasty. The studies included were randomized controlled trials (RCTs), English written, and compared pre-surgical outcomes to post-surgical outcomes in physical therapy interventions. Quality scoring was assessed using the PEDro scale for RCTs. Results: Ten articles met the inclusion criteria. The quality score ranged from 4-7 on the PEDro scale. Results found pre- operative PT in both total knee and total hip arthroplasty reduced the risk of discharge to a rehabilitation facility. Pain reduction (p < 0.05) was found with pool interventions versus land interventions immediately following an exercise session. Discussion: The results indicate there were benefits in the use of pre-operative PT on improving patient satisfaction, pain reduction, and discharge to a lower cost of care setting. The use of pre-operative physical therapy resulted in mixed findings in functional outcomes however. Conclusions: This updated systematic review suggests the current literature on pre-operative physical therapy is inconclusive regarding impact of improving post-surgical outcomes on patients receiving total knee and/or hip arthroplasty.