Efficacy of preoperative rehabilitation for total knee replacement: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Hui ¹ , HAO Xueyun ¹ , SHUAI Ting ² , DENG Yonghong ¹ , ZENG Zi ² ,  SONG Guomin ³

1. Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
2. School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
3. Department of Nursing, Tianjin Hospital, Tianjin, 400211, P.R.China;

Corresponding author：

SONG Guomin, Email: songguomin134@163.com

Keywords：

Preoperative; Rehabilitation; Total knee replacement; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201701093

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Objective To systematically review the efficacy of preoperative rehabilitation for patients with total knee replacement. Methods Electronic databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) about preoperative rehabilitation for total knee replacement from inception to January 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. Results A total of 13 RCTs involving 745 patients were included. The results of meta-analysis showed that, the TUG scores (6 weeks: MD=–1.31, 95%CI –2.29 to –0.32, P=0.009; 3 months: MD=–1.59, 95%CI –2.03 to –1.15, P<0.000 01), 3 months knee flexion ROM scores (MD=4.75, 95%CI 0.63 to 8.86, P=0.02) in the preoperative rehabilitation group were higher than those in the control group. The 3 months VAS scores (MD=–0.95, 95%CI –1.70 to –0.20, P=0.01) in the preoperative rehabilitation group was lower than that in the control group. There were no statistical differences between two groups in WOMAC scores (MD=–5.61, 95%CI –12.84 to 1.62, P=0.13), SF-36 scores (MD=13.15, 95%CI –10.51 to 36.81, P=0.28), knee extension ROM scores (6 weeks: MD=0.60, 95%CI –1.02 to 2.21, P=0.47; 3 months: MD=–2.76, 95%CI –8.45 to 2.92, P=0.34), HSS scores (MD=0.54, 95%CI –0.46 to 1.54, P=0.29), and 6 minutes test scores (MD=–8.75, 95%CI –51.53 to 34.03, P=0.69). Conclusion Current evidence shows that preoperative rehabilitation can improve the postoperative knee function after operation and significantly reduce the pain. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.

Citation： ZHANG Hui, HAO Xueyun, SHUAI Ting, DENG Yonghong, ZENG Zi, SONG Guomin. Efficacy of preoperative rehabilitation for total knee replacement: a systematic review. Chinese Journal of Evidence-Based Medicine, 2017, 17(9): 1060-1065. doi: 10.7507/1672-2531.201701093 Copy

1.	Smith WA, Zucker-Levin A, Mihalko WM, et al. Physical function and physical activity in obese adults after total knee arthroplasty. Orthop Clin North Am, 2017, 48(2): 117-125.
2.	Singh JA. Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J, 2010, 5(1): 80-85.
3.	陈玲敏, 张燕姿, 宋健楠, 等. 全膝关节置换术围手术期疼痛管理. 华西医学, 2016(1): 180-183.
4.	Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol, 2006, 18(5): 526-530.
5.	Wylde V, Dieppe P, Hewlett S, et al. Total knee replacement: is it really an effective procedure for all? Knee, 2007, 14(6): 417-423.
6.	Wylde V, Hewlett S, Learmonth ID, et al. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain, 2011, 152(3): 566-572.
7.	Ditmyer MM, Topp R, Pifer M. Prehabilitation in preparation for orthopaedic surgery. Orthop Nurs, 2002, 21(21): 43-51.
8.	Gill SD, Mcburney H. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil, 2013, 94(1): 164-176.
9.	Silkman Baker C, McKeon JM. Does preoperative rehabilitation improve patient-based outcomes in persons who have undergone total knee arthroplasty? A systematic review. PM R, 2012, 4(10): 756-767.
10.	Shoemaker MJ, Gibson G, Saagman S, et al. Preoperative exercise in individuals undergoing total knee arthroplasty: state of the evidence. Top Geriatr Rehabil, 2013, 29(1): 2-16.
11.	Simmons L, Smith T. Effectiveness of pre-operative physiotherapy-based programmes on outcomes following total knee arthroplasty: a systematic review and meta-analysis. Phys Ther Rev, 2013, 18(1): 1-10.
12.	Chesham RA, Shanmugam S. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review. Physiother Theory Pract, 2017, 33(1): 9-30.
13.	吴在德, 吴肇汉. 外科学. 第七版. 北京: 人民卫生出版社, 2008: 1-957.
14.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available at: http://www.cochrane-handbook.org.
15.	D’Lima DD, Colwell CC, Morris BA, et al. The effect of preoperative exercise on total knee replacement outcomes. Clin Orthop Relat Res, 1996, 326(326): 174-182.
16.	Williamson L, Wyatt MR, Yein K, et al. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology, 2007, 46(9): 1445-1449.
17.	Evgeniadis G, Beneka A, Malliou P, et al. Effects of pre-or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis. J Back Musculoskelet Rehabil, 2008, 21(3): 161-169.
18.	Topp R, Swank AM, Quesada PM, et al. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R, 2009, 1(8): 729-735.
19.	Gstoettner M, Raschner C, Dirnberger E, et al. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee, 2011, 18(4): 265-270.
20.	皮衍玲, 王雪强, 杨树芬, 等. 全膝关节置换术前本体感觉训练对术后的影响. 中国康复, 2011, 26(5): 350-352.
21.	Tungtrongjit Y, Weingkum P, Saunkool P. The effect of preoperative quadriceps exercise on functional outcome after total knee arthroplasty. J Med Assoc Thai, 2012, 95(Suppl 10): 58-66.
22.	Brown K, Topp R, Brosky JA, et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Percept Mot Skills, 2012, 115(3): 765-774.
23.	Matassi F, Duerinckx J, Vandenneucker H, et al. Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 703-709.
24.	陈红云, 贾晗, 陈嘉怡, 等. 术前长期功能锻炼对全膝关节置换术后康复效果的影响. 实用医学杂志, 2014, 30(24): 4031-4033.
25.	Skoffer B, Maribo T, Mechlenburg I, et al. Efficacy of pre-operative progressive resistance training on post-operative outcomes in patients undergoing total knee arthroplasty. Arthritis Care Res, 2016, 68(9): 1239.
26.	Calatayud J, Casaña J, Ezzatvar Y, et al. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2016, DOI: 10.1007/s00167-016-3985-5.
27.	杨延砚, 吴同绚, 张巧云, 等. 个体化术前康复对全膝关节置换术后 6 周功能转归的影响. 中国康复理论与实践, 2016, 22(6): 701-708.
28.	王健. 人工膝关节置换围手术期规范化疼痛管理. 广东: 南方医科大学, 2014.
29.	邱坤. 人工全膝关节置换术后疼痛原因综合分析. 长春: 吉林大学, 2016.
30.	何涛. 全膝关节置换患者术前心理状态与术后膝关节功能康复的相关性研究. 乌鲁木齐: 新疆医科大学, 2012.

1. Smith WA, Zucker-Levin A, Mihalko WM, et al. Physical function and physical activity in obese adults after total knee arthroplasty. Orthop Clin North Am, 2017, 48(2): 117-125.
2. Singh JA. Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J, 2010, 5(1): 80-85.
3. 陈玲敏, 张燕姿, 宋健楠, 等. 全膝关节置换术围手术期疼痛管理. 华西医学, 2016(1): 180-183.
4. Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol, 2006, 18(5): 526-530.
5. Wylde V, Dieppe P, Hewlett S, et al. Total knee replacement: is it really an effective procedure for all? Knee, 2007, 14(6): 417-423.
6. Wylde V, Hewlett S, Learmonth ID, et al. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain, 2011, 152(3): 566-572.
7. Ditmyer MM, Topp R, Pifer M. Prehabilitation in preparation for orthopaedic surgery. Orthop Nurs, 2002, 21(21): 43-51.
8. Gill SD, Mcburney H. Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil, 2013, 94(1): 164-176.
9. Silkman Baker C, McKeon JM. Does preoperative rehabilitation improve patient-based outcomes in persons who have undergone total knee arthroplasty? A systematic review. PM R, 2012, 4(10): 756-767.
10. Shoemaker MJ, Gibson G, Saagman S, et al. Preoperative exercise in individuals undergoing total knee arthroplasty: state of the evidence. Top Geriatr Rehabil, 2013, 29(1): 2-16.
11. Simmons L, Smith T. Effectiveness of pre-operative physiotherapy-based programmes on outcomes following total knee arthroplasty: a systematic review and meta-analysis. Phys Ther Rev, 2013, 18(1): 1-10.
12. Chesham RA, Shanmugam S. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review. Physiother Theory Pract, 2017, 33(1): 9-30.
13. 吴在德, 吴肇汉. 外科学. 第七版. 北京: 人民卫生出版社, 2008: 1-957.
14. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available at: http://www.cochrane-handbook.org.
15. D’Lima DD, Colwell CC, Morris BA, et al. The effect of preoperative exercise on total knee replacement outcomes. Clin Orthop Relat Res, 1996, 326(326): 174-182.
16. Williamson L, Wyatt MR, Yein K, et al. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology, 2007, 46(9): 1445-1449.
17. Evgeniadis G, Beneka A, Malliou P, et al. Effects of pre-or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis. J Back Musculoskelet Rehabil, 2008, 21(3): 161-169.
18. Topp R, Swank AM, Quesada PM, et al. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R, 2009, 1(8): 729-735.
19. Gstoettner M, Raschner C, Dirnberger E, et al. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee, 2011, 18(4): 265-270.
20. 皮衍玲, 王雪强, 杨树芬, 等. 全膝关节置换术前本体感觉训练对术后的影响. 中国康复, 2011, 26(5): 350-352.
21. Tungtrongjit Y, Weingkum P, Saunkool P. The effect of preoperative quadriceps exercise on functional outcome after total knee arthroplasty. J Med Assoc Thai, 2012, 95(Suppl 10): 58-66.
22. Brown K, Topp R, Brosky JA, et al. Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study. Percept Mot Skills, 2012, 115(3): 765-774.
23. Matassi F, Duerinckx J, Vandenneucker H, et al. Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 703-709.
24. 陈红云, 贾晗, 陈嘉怡, 等. 术前长期功能锻炼对全膝关节置换术后康复效果的影响. 实用医学杂志, 2014, 30(24): 4031-4033.
25. Skoffer B, Maribo T, Mechlenburg I, et al. Efficacy of pre-operative progressive resistance training on post-operative outcomes in patients undergoing total knee arthroplasty. Arthritis Care Res, 2016, 68(9): 1239.
26. Calatayud J, Casaña J, Ezzatvar Y, et al. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2016, DOI: 10.1007/s00167-016-3985-5.
27. 杨延砚, 吴同绚, 张巧云, 等. 个体化术前康复对全膝关节置换术后 6 周功能转归的影响. 中国康复理论与实践, 2016, 22(6): 701-708.
28. 王健. 人工膝关节置换围手术期规范化疼痛管理. 广东: 南方医科大学, 2014.
29. 邱坤. 人工全膝关节置换术后疼痛原因综合分析. 长春: 吉林大学, 2016.
30. 何涛. 全膝关节置换患者术前心理状态与术后膝关节功能康复的相关性研究. 乌鲁木齐: 新疆医科大学, 2012.

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