Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) represent two of the most common procedures in orthopedic surgery. The growing need to avoid physical impairment in elderly patients undergoing this kind of surgery puts the focus on the possibility to undertake a preoperative physical activity program to improve their fit and physical health at the time of surgery. A systematic review has been carried out with online databases including PubMed-Medline, Cochrane Central and Google Scholar. The aim was to retrieve available evidence concerning preoperative physical activity and exercise, before total knee or total hip arthroplasty in patients older than 65 years, and to clarify the role of this practice in improving postoperative outcomes. Results of the present systematic analysis showed that, for TKA, most of the studies demonstrated a comparable trend of postoperative improvement of Visual Analogue Scale (VAS), range of movement (ROM) and functional scores, and those of quality of life. There is insufficient evidence in the literature to draw final conclusions on the topic. Prehabilitation for patients undergoing TKA leads to shorter length of stay but not to an enhanced postoperative recovery. Concerning THA, although currently available data showed better outcomes in patients who underwent prehabilitation programs, there is a lack of robust evidence with appropriate methodology.
Highlights
The prevalence of osteoarthritis in the elderly population is relevant, especially for lower limb weight-bearing joints
All the studies analyzed in the present review reported an intervention length ranging between 2 and 6 weeks, which is shorter than the minimum length, and most of them used home-based exercise programs, so it is difficult to have trustable data on whether the patients followed the indications for resistance thresholds or not
As an added value in comparison to previous similar works, our study strictly focuses on elderly patients, for which outcomes seem to be more homogeneous and consistent than those in other age groups
Summary
The prevalence of osteoarthritis in the elderly population is relevant, especially for lower limb weight-bearing joints. Arthroplasty aims to restore the function of the joint and soothe the pain derived from bone-on-bone arthritic conditions. After hip and knee arthroplasty, a consistent rehabilitation program is usually undertaken in order to provide the patient with the adequate strength and mobility to bear the prosthetic implant and to guarantee a correct function [1]. Isometric strengthening of the muscle responsible for the index joint movement (gluteal muscles for the hip and quadriceps for the knee) is a key feature of postoperative rehabilitation, providing the limb with the appropriate muscular support for the mobilization of the hip or the knee. Neuromuscular education to walking is advocated to eventually restore the locomotor function of the limb [3]
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