Does Preoperative Rehabilitation Improve Patient-Based Outcomes in Persons Who Have Undergone Total Knee Arthroplasty? A Systematic Review

Abstract

Common clinical practice includes attempts to improve pain, function, motion, and patient independence before total knee arthroplasty (TKA) surgery. Although preoperative rehabilitation often is prescribed, it is unknown whether this care improves patient outcomes after TKA surgery. To focus on how TKA preoperative rehabilitation affects quality of life, pain, and physical outcomes after surgery. A computerized search was performed in February 2011. We searched PubMed, Ageline, CIHNAL, and SPORTDiscus from 1950 through February 2011 using combinations of the terms knee, rehabilitation, arthroplasty, preoperative, and presurgical. Searches were limited to "human" and "English" studies reported in peer-review journals. Seven studies met the inclusion criteria. For all variables, none was consistently favorable toward preoperative rehabilitation over alternative or control treatment. Means and standard deviations (SDs) for each category of the Western Ontario and McMaster Osteoarthritis Index (WOMAC), range of motion, and length of stay (LOS) were obtained and served to calculate point measures and measures of variability. Specifically, bias-adjusted Hedges' g effect sizes, along with 95% confidence intervals, were calculated to assess the magnitude of the treatment effect for each outcome, with separate meta-analyses performed as a summary of the treatment response for each outcome. A total of 240 studies were identified in the search of the literature. On the basis of the title, abstract, or study content, 203 studies were excluded. Of the remaining 37 studies, 30 were excluded on the basis of study design and choice of outcome measures. The results of this review indicate that preoperative rehabilitation likely had no true treatment effect on WOMAC scores, range of motion, and LOS because all effect sizes were weak (<0.4) and confidence intervals crossed zero. For all outcomes, none was consistently favorable toward preoperative rehabilitation over the alternative for patients undergoing TKA with the exception of LOS in favor of the treatment group.