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Asian Journal of Surgery Oct 2021Progressive resistance training (PRT) is one of the most commonly used exercise methods after joint replacement, while its effectiveness and safety are still... (Meta-Analysis)
Meta-Analysis Review
Progressive resistance training (PRT) is one of the most commonly used exercise methods after joint replacement, while its effectiveness and safety are still controversial. Therefore, it's vital to investigate the effect of PRT on muscle strength and functional capacity early postoperative total hip arthroplasty (THA) or total knee arthroplasty (TKA). Relevant studies were identified via a search of Medline, Web of science and Cochrane Library from 2002 to 12 May 2020. Fifteen of 704 studies which comprised 6 THAs and 8 TKAs, involving 1021 adult patients were eligible for inclusion in the meta-analysis. There were no significant differences between the two groups after TKA in the 6-min walk test (6-WMT) within 1 month (95% CI = -0.41, 1.53), within 3 months (95% CI = -0.27, 0.76), within 12 months (95% CI = -0.29, 0.66); climb performance in seconds (s) (SCP), leg extension power, timed up and go test in seconds (s) (TUG) within 1 month (95% CI = -1.75, 0.77), within 3 months (95% CI = -0.48, 0.33), within 12 months (95% CI = -0.44, 0.35), sit to stand, number of repetitions in 30s (ST). There was no difference in the incidence of adverse events (95% CI = -0.01, 0.10). Similarly, two groups were also no obvious distinction after THA in the 6-WMT, SCP, Leg extension power, ST. PRT early after THA or TKA did not differ significantly from SR in terms of functional capacity, muscle strength recovery and incidence of adverse events. PRT is one of the options for rapid rehabilitation after joint replacement.
Topics: Adult; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Postural Balance; Resistance Training; Time and Motion Studies
PubMed: 33715964
DOI: 10.1016/j.asjsur.2021.02.007 -
Orthopaedics & Traumatology, Surgery &... Nov 2017In spite of improvements in implant designs and surgical precision, functional outcomes of mechanically aligned total knee arthroplasty (MA TKA) have plateaued. This... (Review)
Review
In spite of improvements in implant designs and surgical precision, functional outcomes of mechanically aligned total knee arthroplasty (MA TKA) have plateaued. This suggests probable technical intrinsic limitations that few alternate more anatomical recently promoted surgical techniques are trying to solve. This review aims at (1) classifying the different options to frontally align TKA implants, (2) at comparing their safety and efficacy with the one from MA TKAs, therefore answering the following questions: does alternative techniques to position TKA improve functional outcomes of TKA (question 1)? Is there any pathoanatomy not suitable for kinematic implantation of a TKA (question 2)? A systematic review of the existing literature utilizing PubMed and Google Scholar search engines was performed in February 2017. Only studies published in peer-reviewed journals over the last ten years in either English or French were reviewed. We identified 569 reports, of which 13 met our eligibility criteria. Four alternative techniques to position a TKA are challenging the traditional MA technique: anatomic (AA), adjusted mechanical (aMA), kinematic (KA), and restricted kinematic (rKA) alignment techniques. Regarding osteoarthritic patients with slight to mid constitutional knee frontal deformity, the KA technique enables a faster recovery and generally generates higher functional TKA outcomes than the MA technique. Kinematic alignment for TKA is a new attractive technique for TKA at early to mid-term, but need longer follow-up in order to assess its true value. It is probable that some forms of pathoanatomy might affect longer-term clinical outcomes of KA TKA and make the rKA technique or additional surgical corrections (realignment osteotomy, retinacular ligament reconstruction etc.) relevant for this sub-group of patients. Longer follow-up is needed to define the best indication of each alternative surgical technique for TKA. Level I for question 1 (systematic review of Level I studies), level 4 for question 2.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Humans; Knee Joint; Knee Prosthesis
PubMed: 28864235
DOI: 10.1016/j.otsr.2017.07.010 -
Regional Anesthesia and Pain Medicine Nov 2021Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. (Meta-Analysis)
Meta-Analysis Review
Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature.
BACKGROUND
Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery.
METHODS
A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations.
RESULTS
Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92).
CONCLUSIONS
Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes.
RECOMMENDATION
PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.
Topics: Analgesia; Anesthesia, Conduction; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Consensus; Humans; Pain, Postoperative; Peripheral Nerves
PubMed: 34433647
DOI: 10.1136/rapm-2021-102750 -
The Journal of Orthopaedic and Sports... May 2019Total shoulder arthroplasty (TSA) is indicated for patients with glenohumeral arthritis. In this procedure, the humeral head and glenoid surface are replaced with...
BACKGROUND
Total shoulder arthroplasty (TSA) is indicated for patients with glenohumeral arthritis. In this procedure, the humeral head and glenoid surface are replaced with prosthetic components. Reverse total shoulder arthroplasty (RTSA) is indicated for patients with glenohumeral arthritis and a poorly functioning rotator cuff. In this procedure, a glenosphere articulates with a humerosocket. While those surgeries are commonly performed, a thorough review of the literature is required to determine the areas of agreement and variations in postoperative rehabilitation.
OBJECTIVES
To describe the literature on rehabilitation protocols following anatomic TSA and RTSA.
METHODS
For this systematic review, a computerized search was conducted in medical databases from inception to May 21, 2018 for relevant descriptive studies on TSA and RTSA rehabilitation protocols. The methodological index for nonrandomized studies tool and the modified Downs and Black tool for randomized controlled trials were used for assessment of the individual studies.
RESULTS
Sixteen studies met the inclusion criteria, of which 1 provided level I evidence, 1 provided level III evidence, 2 provided level IV evidence, and 12 provided level V evidence. Ten of the studies described rehabilitation guidelines for TSA and 6 described those for RTSA. Following TSA, the use of a sling was recommended for a duration that varied from 3 to 8 weeks, and 4 of the 10 published protocols included resisted exercise during the initial stage of healing (the first 6 weeks after surgery). Seven of 10 published protocols recommended limiting shoulder external rotation to 30° and that passive range of motion be fully restored by 12 weeks post surgery. Suggested use of a sling post RTSA varied from "for comfort only" to 6 weeks, motion parameters varied from no passive range of motion to precautionary range limits, and all protocols agreed on performing deltoid isometric exercises early post surgery. There was a high level of heterogeneity for the rehabilitation guidelines and associated precautions for both TSA and RTSA.
CONCLUSION
The majority of published protocols were descriptive in nature. Published rehabilitation strategies following TSA and RTSA are based on biomechanical principles, healing time frames, and exercise loading principles, with little consistency among protocols. There is a need to determine optimal rehabilitation approaches post TSA and RTSA based on clinical outcomes.
LEVEL OF EVIDENCE
Therapy, level 5. .
Topics: Arthroplasty, Replacement, Shoulder; Humans; Physical Therapy Modalities; Practice Guidelines as Topic
PubMed: 31021690
DOI: 10.2519/jospt.2019.8616 -
Postgraduate Medical Journal Dec 2017To collect data of randomised controlled trials (RCTs) and clinical controlled trials (CCTs) for evaluating the effects of enhanced recovery after surgery on... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To collect data of randomised controlled trials (RCTs) and clinical controlled trials (CCTs) for evaluating the effects of enhanced recovery after surgery on postoperative recovery of patients who received total hip arthroplasty (THA) or total knee arthroplasty (TKA).
METHODS
Relevant, published studies were identified using the following key words: arthroplasty, joint replacement, enhanced recovery after surgery, fast track surgery, multi-mode analgesia, diet management, or steroid hormones. The following databases were used to identify the literature consisting of RCTs or CCTs with a date of search of 31 December 2016: PubMed, Cochrane, Web of knowledge, Ovid SpringerLink and EMBASE. All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were postoperative length of stay (LOS), 30-day readmission rate, and total incidence of complications. RevMan5.2. software was adopted for the meta-analysis.
RESULTS
A total of 10 published studies (9936 cases) met the inclusion criteria. The cumulative data included 4205 cases receiving enhanced recovery after surgery (ERAS), and 5731 cases receiving traditional recovery after surgery (non-ERAS). The meta-analysis showed that LOS was significantly lower in the ERAS group than in the control group (non-ERAS group) (p<0.01), and there were fewer incidences of complications in the ERAS group than in the control group (p=0.03). However, no significant difference was found in the 30-day readmission rate (p=0.18).
CONCLUSIONS
ERAS significantly reduces LOS and incidence of complications in patients who have had THA or TKA. However, ERAS does not appear to significantly impact 30-day readmission rates.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Length of Stay; Patient Readmission; Postoperative Complications; Recovery of Function
PubMed: 28751437
DOI: 10.1136/postgradmedj-2017-134991 -
The Journal of Bone and Joint Surgery.... Oct 2021Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical...
BACKGROUND
Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical procedure. This study aimed to systematically review the effect of ERAS after primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay, total procedure-related morbidity, and readmission.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with guidance from the Cochrane Handbook for Systematic Reviews of Interventions. MEDLINE, Embase, and Cochrane databases were searched from inception (1946 for MEDLINE and 1974 for Embase; Cochrane is a composite of multiple databases and thus does not report a standard inception date) until January 15, 2020. Prospective nonrandomized cohort studies and randomized controlled trials comparing adult patients undergoing elective primary THA or TKA with ERAS or traditional protocols were included. Articles examining outpatient, nonelective, or revision surgical procedures were excluded. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was length of stay. The secondary outcomes included total procedure-related morbidity and readmission.
RESULTS
Of the 1,018 references identified (1,017 identified through an electronic search and 1 identified through a manual search), 9 individual studies met inclusion criteria. Data were reported from 7,789 participants, with 2,428 receiving ERAS and 5,361 receiving traditional care. Narrative synthesis was performed instead of meta-analysis, given the presence of moderate to high risk of bias, wide variation of ERAS interventions, and inconsistent methods for assessing and reporting outcomes among included studies. Adherence to ERAS protocols consistently reduced hospital length of stay. Few studies demonstrated reduced total procedure-related morbidity, and there was no significant effect on readmission rates.
CONCLUSIONS
ERAS likely reduced the length of stay after primary elective THA and TKA, with a more pronounced effect in selected healthier patient populations. We found minimal to no impact on perioperative morbidity or readmission. The quality of existing evidence was limited because of study heterogeneity and a significant risk of bias. Further high-quality research is needed to definitively assess the impact of ERAS on total joint arthroplasty.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Enhanced Recovery After Surgery; Humans; Recovery of Function
PubMed: 34166275
DOI: 10.2106/JBJS.20.02169 -
British Journal of Anaesthesia Sep 2019Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. (Meta-Analysis)
Meta-Analysis
Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis.
BACKGROUND
Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes.
METHODS
The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations.
RESULTS
The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57-0.80/OR: 0.83, 95% CI: 0.60-1.15; pulmonary OR: 0.65, 95% CI: 0.52-0.80/OR: 0.69, 95% CI: 0.58-0.81; acute renal failure OR: 0.69, 95% CI: 0.59-0.81/OR: 0.73, 95% CI: 0.65-0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42-0.65/OR: 0.77, 95% CI: 0.64-0.93; infections OR: 0.73, 95% CI: 0.67-0.79/OR: 0.80, 95% CI: 0.76-0.85; and blood transfusion OR: 0.85, 95% CI: 0.82-0.89/OR: 0.84, 95% CI: 0.82-0.87.
CONCLUSIONS
Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation.
RECOMMENDATION
neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty.
TRIAL REGISTRY NUMBER
PROSPERO CRD42018099935.
Topics: Anesthesia, Epidural; Anesthesia, General; Anesthesia, Spinal; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Evidence-Based Medicine; Humans; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31351590
DOI: 10.1016/j.bja.2019.05.042 -
The Cochrane Database of Systematic... Feb 2022Hip fractures are a major healthcare problem, presenting a huge challenge and burden to individuals and healthcare systems. The number of hip fractures globally is... (Review)
Review
BACKGROUND
Hip fractures are a major healthcare problem, presenting a huge challenge and burden to individuals and healthcare systems. The number of hip fractures globally is rising rapidly. The majority of hip fractures are treated surgically. This review evaluates evidence for types of arthroplasty: hemiarthroplasties (HAs), which replace part of the hip joint; and total hip arthroplasties (THAs), which replace all of it.
OBJECTIVES
To determine the effects of different designs, articulations, and fixation techniques of arthroplasties for treating hip fractures in adults.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, seven other databases and one trials register in July 2020.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs comparing different arthroplasties for treating fragility intracapsular hip fractures in older adults. We included THAs and HAs inserted with or without cement, and comparisons between different articulations, sizes, and types of prostheses. We excluded studies of people with specific pathologies other than osteoporosis and with hip fractures resulting from high-energy trauma.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We collected data for seven outcomes: activities of daily living, functional status, health-related quality of life, mobility (all early: within four months of surgery), early mortality and at 12 months after surgery, delirium, and unplanned return to theatre at the end of follow-up.
MAIN RESULTS
We included 58 studies (50 RCTs, 8 quasi-RCTs) with 10,654 participants with 10,662 fractures. All studies reported intracapsular fractures, except one study of extracapsular fractures. The mean age of participants in the studies ranged from 63 years to 87 years, and 71% were women. We report here the findings of three comparisons that represent the most substantial body of evidence in the review. Other comparisons were also reported, but with many fewer participants. All studies had unclear risks of bias in at least one domain and were at high risk of detection bias. We downgraded the certainty of many outcomes for imprecision, and for risks of bias where sensitivity analysis indicated that bias sometimes influenced the size or direction of the effect estimate. HA: cemented versus uncemented (17 studies, 3644 participants) There was moderate-certainty evidence of a benefit with cemented HA consistent with clinically small to large differences in health-related quality of life (HRQoL) (standardised mean difference (SMD) 0.20, 95% CI 0.07 to 0.34; 3 studies, 1122 participants), and reduction in the risk of mortality at 12 months (RR 0.86, 95% CI 0.78 to 0.96; 15 studies, 3727 participants). We found moderate-certainty evidence of little or no difference in performance of activities of daily living (ADL) (SMD -0.03, 95% CI -0.21 to 0.16; 4 studies, 1275 participants), and independent mobility (RR 1.04, 95% CI 0.95 to 1.14; 3 studies, 980 participants). We found low-certainty evidence of little or no difference in delirium (RR 1.06, 95% CI 0.55 to 2.06; 2 studies, 800 participants), early mortality (RR 0.95, 95% CI 0.80 to 1.13; 12 studies, 3136 participants) or unplanned return to theatre (RR 0.70, 95% CI 0.45 to 1.10; 6 studies, 2336 participants). For functional status, there was very low-certainty evidence showing no clinically important differences. The risks of most adverse events were similar. However, cemented HAs led to less periprosthetic fractures intraoperatively (RR 0.20, 95% CI 0.08 to 0.46; 7 studies, 1669 participants) and postoperatively (RR 0.29, 95% CI 0.14 to 0.57; 6 studies, 2819 participants), but had a higher risk of pulmonary embolus (RR 3.56, 95% CI 1.26 to 10.11, 6 studies, 2499 participants). Bipolar HA versus unipolar HA (13 studies, 1499 participants) We found low-certainty evidence of little or no difference between bipolar and unipolar HAs in early mortality (RR 0.94, 95% CI 0.54 to 1.64; 4 studies, 573 participants) and 12-month mortality (RR 1.17, 95% CI 0.89 to 1.53; 8 studies, 839 participants). We are unsure of the effect for delirium, HRQoL, and unplanned return to theatre, which all indicated little or no difference between articulation, because the certainty of the evidence was very low. No studies reported on early ADL, functional status and mobility. The overall risk of adverse events was similar. The absolute risk of dislocation was low (approximately 1.6%) and there was no evidence of any difference between treatments. THA versus HA (17 studies, 3232 participants) The difference in the risk of mortality at 12 months was consistent with clinically relevant benefits and harms (RR 1.00, 95% CI 0.83 to 1.22; 11 studies, 2667 participants; moderate-certainty evidence). There was no evidence of a difference in unplanned return to theatre, but this effect estimate includes clinically relevant benefits of THA (RR 0.63, 95% CI 0.37 to 1.07, favours THA; 10 studies, 2594 participants; low-certainty evidence). We found low-certainty evidence of little or no difference between THA and HA in delirium (RR 1.41, 95% CI 0.60 to 3.33; 2 studies, 357 participants), and mobility (MD -0.40, 95% CI -0.96 to 0.16, favours THA; 1 study, 83 participants). We are unsure of the effect for early functional status, ADL, HRQoL, and mortality, which indicated little or no difference between interventions, because the certainty of the evidence was very low. The overall risks of adverse events were similar. There was an increased risk of dislocation with THA (RR 1.96, 95% CI 1.17 to 3.27; 12 studies, 2719 participants) and no evidence of a difference in deep infection.
AUTHORS' CONCLUSIONS
For people undergoing HA for intracapsular hip fracture, it is likely that a cemented prosthesis will yield an improved global outcome, particularly in terms of HRQoL and mortality. There is no evidence to suggest a bipolar HA is superior to a unipolar prosthesis. Any benefit of THA compared with hemiarthroplasty is likely to be small and not clinically appreciable. We encourage researchers to focus on alternative implants in current clinical practice, such as dual-mobility bearings, for which there is limited available evidence.
Topics: Activities of Daily Living; Aged; Arthroplasty, Replacement, Hip; Female; Hip Fractures; Hip Joint; Humans; Middle Aged; Quality of Life
PubMed: 35156194
DOI: 10.1002/14651858.CD013410.pub2 -
The Journal of Arthroplasty Mar 2015The objective of this study is to compare the clinical, radiographic and surgical outcomes among patients undergoing primary THA performed via the anterior versus... (Comparative Study)
Comparative Study Meta-Analysis Review
The objective of this study is to compare the clinical, radiographic and surgical outcomes among patients undergoing primary THA performed via the anterior versus posterior approach. We searched numerous sources and eventually included 17 studies, totaling 2302 participants. In terms of post-operative pain and function, the anterior approach was significantly favored in 4 studies at short-term follow-up. Pooled estimates showed a significant difference in favor of the anterior approach in terms of length of stay and dislocations. Current evidence comparing outcomes following anterior versus posterior THA does not demonstrate clear superiority of either approach. Until more rigorous, randomized evidence is available, we recommend choice of surgical approach for THA be based on patient characteristics, surgeon experience and surgeon and patient preference.
Topics: Arthroplasty, Replacement, Hip; Humans; Osteoarthritis, Hip
PubMed: 25453632
DOI: 10.1016/j.arth.2014.10.020 -
Medicina (Kaunas, Lithuania) May 2022: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both... (Review)
Review
: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. : A systematic literature search was performed in the online databases PubMed, PEDro and Cochrane Library using the following search keywords: "prehabilitation", "preoperative care", and "total hip replacement". : A total of 400 potentially relevant studies were identified. After title, abstract and full-text screening, 14 studies fulfilled all inclusion criteria and were included in this systematic review. Patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention in the following tests: six-minute walk test, Timed Up and Go test, chair-rise test, and stair climbing. For various other assessments, such as the widely used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip disability and Osteoarthritis Outcome Score (HOOS), 36-item Short Form Survey (SF-36) and Barthel Index, no significant differences in outcomes regarding exercise therapy were reported in the included studies. Education alone had no effect on postoperative outcomes. : Prehabilitation in the form of a prehabilitation exercise therapy is an effective prehabilitation measure with regard to postoperative physical functioning, while prehabilitation in the form of education has no significant effects. No negative effects of prehabilitation on the outcomes examined were reported.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Osteoarthritis; Postural Balance; Preoperative Care; Preoperative Exercise; Time and Motion Studies
PubMed: 35744005
DOI: 10.3390/medicina58060742