Effects of Resistance Training Prior to Total Hip or Knee Replacement on Post-operative Recovery in Functional Performance: A Systematic Review and Meta-Analysis

Stian Langgård Jørgensen; Signe Kierkegaard; Marie Bagger Bohn; Per Aagaard; Inger Mechlenburg

doi:10.3389/fspor.2022.924307

Effects of Resistance Training Prior to Total Hip or Knee Replacement on Post-operative Recovery in Functional Performance: A Systematic Review and Meta-Analysis

Front Sports Act Living. 2022 Jul 14:4:924307. doi: 10.3389/fspor.2022.924307. eCollection 2022.

Authors

Stian Langgård Jørgensen^{1

2

3

4}, Signe Kierkegaard^{2

3

4}, Marie Bagger Bohn^{2

3

4}, Per Aagaard⁵, Inger Mechlenburg^{4

6}

Affiliations

¹ Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark.
² Horsens Research Centre - Hip Training & Preservation Surgery (H-HIP), Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark.
³ Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark.
⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁵ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁶ Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.

Abstract

Objective: To evaluate the effectiveness of pre-operative resistance training in patients allocated to TJR surgery on selected post-operative outcomes, via a meta-analysis of studies using exercise modalities and loading intensities objectively known to promote gains in muscle size and strength in adults of young-to-old age.

Design: A systematic review and meta-analysis.

Literature search: Cochrane Central, MEDLINE, EMBASE, and PEDro were searched on August 4th 2021.

Study selection: Randomized Controlled Trials (RCTs) were included if (i) they compared pre-operative lower-limb-exercises before elective TJR with standard care, (ii) explicitly reported the exercise intensity, and (iii) reported data on functional performance.

Data synthesis: This systematic review and meta-analysis is reported in accordance with the PRISMA reporting guidelines. A random effects model with an adjustment to the confidence interval was performed for pooling the data.

Results: One thousand studies were identified. After applying exclusion criteria, five RCTs were located including 256 participants (mean age ranged from 61 to 72 years, 54% women). Moderate-to-large improvements in functional performance and maximal knee extensor strength were observed at 3 months after surgery along with small-to-moderate effects 12 months post-operatively. For patient-reported outcomes, small-to-moderate improvements were observed at 3 months post-operatively with no-to-small improvements at 12 months.

Conclusion: Prehabilitation efforts involving progressive resistance training provides an effective means to improve post-operative outcomes related to functional performance, knee extensor strength and patient-reported outcome in patients undergoing TJR. Due to large methodological diversity between studies, an optimal loading intensity remains unknown.

Systematic review registration: Prospero ID: CRD42021264796.

Keywords: functional performance; muscle strength; orthopedics; patient reported outcomes; prehabilitation.

Publication types

Systematic Review