This study aimed to evaluate the effects of preoperative rehabilitation on early postoperative outcomes in patients scheduled for TKA.This study aimed to evaluate the effects of preoperative rehabilitation on early postoperative outcomes in patients scheduled for TKA.
Thirty-nine patients scheduled for primary TKA were included if they were able to walk independently, whereas patients with significant comorbidities (heart disease, cerebrovascular disease, dementia) were excluded. Sixteen patients who consented to undergo preoperative rehabilitation were designated as the treatment group and evaluated at baseline (start of rehabilitation), admission and postoperative 3 weeks. The control group was evaluated at baseline (admission) and discharge.
Outcome measures included the Numerical Rating Scale (NRS) score for pain at rest and during walking, knee ROM, knee-extensor strength, 30-second sit-to-stand test (CS-30), 40-meter Fast Paced Walk Test and stair-climbing test (SCT). The SCT results were excluded for the participants unable to perform it. Other outcomes included hospital-stay length, cane use and stair-climbing ability at discharge.
The preoperative rehabilitation program involved lower-limb strengthening, closed kinetic-chain exercises and stationary-bike aerobic exercise performed twice per week for 8 weeks (16 sessions) for 40 minutes per session. Paired t-tests were performed for pre- and post-rehabilitation comparisons in the treatment group, and unpaired t-tests were performed to compare the two groups at baseline and for the baseline-to-discharge changes (significance level of 5%).
In the treatment group, significant improvements were observed after preoperative rehabilitation except for resting pain and knee-extensor strength on the non-surgical side. At baseline, there were no significant differences in the sex ratio, age, body mass index or severity (Kellgren–Lawrence grade) between the treatment and control groups, but walking pain was significantly higher in the treatment group (p 0.005). The baseline to postoperative 3-week changes in the NRS pain scores were significantly greater in the treatment group (−5.5 ± 2.3 points) than in the control group (−3.5 ± 3.3 points, p 0.05). The change in the SCT result was significantly smaller in the treatment group (+3.5 ± 6.8 seconds) than in the control group (+27.3 ± 12.5 seconds, p 0.001). Additionally, 3 treatment-group and 10 control-group participants were unable to ascend and descend stairs at discharge.
Worsening of pain and decreased stair-climbing ability after TKA were significantly less pronounced in the treatment group than in the control group. We found that this treatment program contributed to pain reduction and improved stair-climbing ability in the participants after TKA.
This treatment program may reduce pain and improve stair-climbing ability, which are major factors contributing to decreased postoperative satisfaction, in larger groups of patients after TKA.
Preoperative Rehabilitation
Motor function
