Preoperative Strength Training for Clinical Outcomes Before and After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Zugui Wu; Yi Wang; Congcong Li; Junyi Li; Weijian Chen; Zixuan Ye; Ziquan Zeng; Kunhao Hong; Yue Zhu; Tao Jiang; Yanyan Lu; Wengang Liu; Xuemeng Xu

doi:10.3389/fsurg.2022.879593

Preoperative Strength Training for Clinical Outcomes Before and After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Front Surg. 2022 Jul 21:9:879593. doi: 10.3389/fsurg.2022.879593. eCollection 2022.

Authors

Zugui Wu¹, Yi Wang¹, Congcong Li¹, Junyi Li¹, Weijian Chen¹, Zixuan Ye¹, Ziquan Zeng^{1

2}, Kunhao Hong^{1

2}, Yue Zhu³, Tao Jiang^{1

2}, Yanyan Lu⁴, Wengang Liu^{1

2}, Xuemeng Xu^{1

2}

Affiliations

¹ The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
² Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China.
³ Baishui Health Center, Qujing, China.
⁴ Luoyang Orthopedic Hospital Of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou, China.

Abstract

Background: There is an increasing interest in preoperative strength training for promoting post-operative rehabilitation, but the effectiveness of preoperative strength training for clinical outcomes after total knee arthroplasty (TKA) remains controversial.

Objective: This study aims to systematically evaluate the effect of preoperative strength training on clinical outcomes before and after TKA.

Methods: We systematically searched PubMed, Cochrane Library, Web of Science, and EMBASE databases from the inception to November 17, 2021. The meta-analysis was performed to evaluate the effects of preoperative strength training on clinical outcomes before and after TKA.

Results: Seven randomized controlled trials (RCTs) were included (n = 306). Immediately before TKA, the pooled results showed significant improvements in pain, knee function, functional ability, stiffness, and physical function in the strength training group compared with the control group, but not in strength (quadriceps), ROM, and WOMAC (total). Compared with the control group, the results indicated strength training had a statistically significant improvement in post-operative knee function, ROM, and functional ability at less than 1 month and 3 months, and had a statistically significant improvement in post-operative strength (quadriceps), stiffness, and WOMAC (total) at 3 months, and had a statistically significant improvement in post-operative pain at 6 months. However, the results indicated strength training had no statistically significant improvement in post-operative strength (quadriceps) at less than 1 month, 6, and 12 months, had no statistically significant improvement in post-operative pain at less than 1 month, 3, and 12 months, had no statistically significant improvement in post-operative knee function at 6 and 12 months, and had no statistically significant improvement in post-operative physical function at 3 months.

Conclusions: Preoperative strength training may be beneficial to early rehabilitation after TKA, but the long-term efficacy needs to be further determined. At the same time, more caution should be exercised when interpreting the clinical efficacy of preoperative strength training for TKA.

Keywords: preoperative; rehabilitation; strength training; systematic review; total knee arthroplasty.

Publication types

Review