Research in Orthopedics
Prehabilitation Before Total Knee Arthroplasty
Total knee arthroplasty (TKA) is a well-established procedure for endstage knee osteoarthritis patients when previous conservative treatments have failed. Preoperative physical and mental preparation, known as “prehabilitation” (prehab) is emerging as a potential strategy for influencing risk factors positively associated with prolonged recovery time. Conflicting evidence on the effectiveness of prehab underscores the importance of individually tailored interventions. We also advocated for this personalized approach in our meta-analyses, which showed limited benefits of standard programs, with effects often diminishing after three months post-surgery.
We therefore evaluated the feasibility and acceptance of a supervised exercise- and education-based program before TKA. Furthermore, secondary objectives focused on assessing preoperative, 6-week, and 12-week post-surgery effects on knee function. Our study addressed a critical gap in understanding the potential of prehab with regard to the optimization of surgical outcomes (Fig. 1). Prehab was well-accepted by patients and facilitated a return to more demanding physical activities before and after TKA, as demonstrated by the KOOS and Tegner Activity Scale. Conducting the program was safe and feasible, although there were barriers to participation such as travel distance. Prehab may not only prevent declines in function between the indication for the surgery and the surgery itself but may also foster a sense of responsibility and ownership in patients with regard to their recovery. Patients should understand that improving their physical condition benefits their overall health and an emphasis should be placed on the importance of self-care before and after surgery.
Prähabilitation vor Knietotalprothese
Die Knietotalprothese (KTP) ist nach Ausschöpfung konservativer Therapien das übliche operative Verfahren bei fortgeschrittener Kniearthrose. Die physische und mentale Vorbereitung auf eine KTP, genannt Prähabilitation (Prähab), kann eine langwierige Rehabilitation nach dem Eingriff mindern. Unsere Studie untersuchte die Durchführbarkeit eines physiotherapeutisch begleiteten Übungs- und Edukationsprogramms im Rahmen einer KTP und dessen Auswirkung vor, 6 und 12 Wochen nach der Operation im Vergleich zur Standardbehandlung. Die Patientinnen und Patienten schätzten das Programm, da es rascher wieder anspruchsvolle Aktivitäten ermöglichte. Die Ergebnisse betonen die Wichtigkeit der Patientenaufklärung über die Vorteile der Prähab, um eine hohe Teilnahme und nachhaltige Umsetzung in der klinischen Praxis sicherzustellen.
At a Glance
Musculoskeletal Prehabilitation
Key Collaborators
Project lead: Prof. Dr. med. Johannes Scherr
Pascale Gränicher, MSc
Prof. Dr. med. Sandro Fucentese
Prof. Dr. Jörg Spörri
Departments and Partners
Balgrist University Hospital: University Centre for Prevention and Sports Medicine
Sports Medical Research Group
Knee Surgery Unit
Maastricht University, CAPHRI School for Public Health and Primary Care
Clinical Relevance
Prehabilitation is well-accepted by patients, and facilitates an accelerated return to more demanding physical activities after TKA.
Further Information
> MJS Publishing