A systematic review and meta-analysis of the effect of preoperative exercise intervention on rehabilitation after total knee arthroplasty

A number of researches indicated preoperative functional exercise may improve the rehabilitation progress. This study aimed to investigate the effect of preoperative exercise intervention on rehabilitation before total knee arthroplasty (TKA) by literature retrieval and meta-analysis.Embase, Cochrane library, PubMed, Ovid, and ClinicalTrials.gov were selected as the search database platforms. All published English articles related to preoperative exercise of TKA from January 2000 to January 2021 were searched with the following keyword strategy: ("preoperative functional exercise" or "prehabilitation exercise") AND ("TKA" or "total knee arthroplasty"). After literature screened according to the inclusion and exclusion criteria, the risk of bias and quality of the included articles were evaluated. RevMan 5.3.5 software was used for analysis to obtain the forest plot and funnel plot.A total of 911 articles were preliminarily searched in this study, and 12 were finally included for the quantitative analysis, comprising 889 patients; the result showed after intervention, the experimental group patients had wider ROM flexion than the control group patients [mean difference (MD) =4.28; 95% CI: 2.28 to 6.28; Z=4.19; P<0.0001]; the experimental group patients were with higher quadriceps strength value than the control group (MD =1.86, 95% CI: 0.58-3.15; Z=2.84, P=0.005); the WOMAC score (The Western Ontario and McMaster Universities Osteoarthritis Index), were higher for the experimental group patients (MD =-10.59; 95% CI: -11.88 to -9.29; Z=16.03; P<0.00001); and the standing and walking test index are higher (MD =-1.29, 95% CI: -1.90 to -0.67; Z=4.08; P<0.001); the quality of life score were higher too for the experimental group patients (MD =1.66; 95% CI: 1.13-2.20; Z=6.08; P<0.00001).Preoperative exercise intervention before TKA can improve knee flexion and flexibility, reduce inflammatory pain and stiffness, improve muscle strength, improve joint function, and thus improve the quality of life of patients.