Total joint arthroplasty (TJA) is one of the most cost-effective and successful interventions in medicine. There are more than 1 million TJAs performed in the United States annually. This number is expected to increase to nearly 4 million by 2030 (4)
Pre-habilitation is the initiation of strength training prior to operation. In theory raising a patient’s baseline strength and ROM could improve post-op recovery time.
Most patients presenting for joint replacement will have a lower baseline strength, ROM, and conditioning status due to years of pain. Patients who delay seeking treatment will have a longer post-op recovery.
Observational studies have showed poor outcomes in those deconditioned compared to those with a higher baseline functional status. (1)
Our results suggest that the single best predictor of pain and function at 6 months after total hip or knee replacement is the subjects baseline pain and function (2)
Due to the low quality of randomized clinical trials, all outcomes have a great risk of bias and all have imprecise results with large CIs. (1) there was a tendency toward favoring prehab.; however, there was insufficient evidence to show any effect with the current data (1)
Future:
More studies should be performed on the potential benefits of pre-habilitation and RCTs would improve the validity of the results.
Conclusion:
Preventing deconditioning may be an effective pre-operative goal for patients with OA and joint disease. Pre-habilitation may play a role in maintaining or raising a patients’ baseline conditioning, ROM, and decreasing pain.
Given this information, PCPs could potentially play a role in improving patients' quality of life with OA and joint disease prior to joint replacement.
References:
1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394179/
2: https://onlinelibrary.wiley.com/doi/epdf/10.1002/1529-0131...
3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790068/
4: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485224/