Content » Vol 49, Issue 4

Review article

Pre-surgery exercise and post-operative physical function of people undergoing knee replacement surgery: A systematic review and meta-analysis of randomized controlled trials

Maria A. Peer , Robert Rush, Peter D. Gallacher, Nigel Gleeson
School of Health Sciences, Queen Margaret University, EH21 6UU Edinburgh, United Kingdom. E-mail:
DOI: 10.2340/16501977-2210


Objective: To summarize the evidence regarding the effectiveness and dose-response characteristics of pre-operative exercise programmes on post-operative physical function following total knee arthroplasty.
Data sources: CINAHL, Cochrane Library, PubMed, SPORTDiscus and EMBASE.
Study selection: Randomized controlled trials were eligible if they provided full description of physiological stress (i.e. mode, frequency, intensity and duration).
Data extraction: Data extraction and evaluation
were performed by one reviewer. Methodological
quality of the selected studies was assessed using the Physiotherapy Evidence Database scale.
Data synthesis: Twelve candidate studies were identified, but only 3 papers satisfied all inclusion criteria: 2 studies evaluated the effect of resistance training and 1 trial investigated proprioceptive training. The latter study elicited significantly enhanced post-operative gains in function for indices of standing balance (overall stability index: Hedges’ g = –1; anteroposterior stability index: Hedges’ g = –1.15; 6 weeks post-surgery). Results of meta-analysis based
on the findings of 2 studies showed that, compared with controls, prehabilitative exercise involving resistance training offered no additional gains in isometric quadriceps muscle strength at 6 and 12 weeks post-operatively.
Conclusion: Despite a potential for efficacy of exercise-based conditioning, this review highlights the scarcity of robust dose-response evidence to guide the formulation of total knee arthroplasty prehabilitation effectively.

Lay Abstract

People with severe knee osteoarthritis experience less pain, improved ability to do every day activities and better quality of life following knee replacement surgery. Nevertheless they often have reduced muscle strength and balance. We summarised the literature to see whether exercises prior to the operation can reduce post-operative limitations. Studies were included if they provided detail information on the exercises programme (i.e. how often, how strenuous, and how long). Three papers described in sufficient detail the exercise that participants performed: two studies evaluated the effect of strength training and one trial investigated balance training. This review highlights insufficient evidence regarding how much exercise a person needs to perform before a total knee arthroplasty to improve their leg strength and balance.


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