Preparing for a New Knee? Why Prehabilitation is Crucial for Total Knee Replacement?
Total knee replacement (TKR) surgery is a common orthopaedic procedure that is typically done to alleviate severe pain and improve mobility in patients with severe osteoarthritis or other degenerative conditions of the knee joint. While the surgical procedure itself is important, the prehabilitation (prehab) phase is just as crucial for achieving the best possible outcome. We are here to fill you in on the importance of knee prehab prior to TKR, the latest scientific evidence supporting it, and some exercises that can be incorporated into a prehab program.
Why is Prehabilitation Important?
Prehabilitation is a set of exercises and activities that are performed before surgery to prepare the body for the upcoming operation. The goals of prehabilitation are to:
Improve overall physical fitness ✓
Strengthen the muscles around the knee joint ✓
Increase the range of motion of the knee joint ✓
Improve balance and coordination ✓
Reduce pain and inflammation in the knee joint ✓
Improve postoperative outcomes ✓
Prehabilitation has been shown to be effective in improving surgical outcomes in various orthopaedic procedures, including total knee replacement. By improving muscle strength, range of motion, and overall fitness, prehabilitation can help reduce the risk of postoperative complications, such as infections and blood clots, and improve functional outcomes, such as the ability to walk and perform daily activities.
Latest Scientific Evidence
A recent study aimed to assess the effectiveness of preoperative exercise interventions on postoperative outcomes for patients undergoing TKR. The authors analysed 18 randomised controlled trials and found that preoperative exercise interventions significantly improved postoperative outcomes such as knee function, range of motion, and quality of life. Furthermore, preoperative exercise interventions were associated with shorter hospital stays, reduced need for rehabilitation, and decreased complication rates. The study suggests that preoperative exercise interventions may be a useful tool in improving the rehabilitation outcomes for patients undergoing TKR.
While a 2017 study aimed to investigate the effects of preoperative exercise and education on postoperative outcomes for patients undergoing total hip and knee replacement. The authors reviewed 21 randomised controlled trials and found that preoperative exercise and education interventions were associated with improved postoperative outcomes, including increased functional outcomes, reduced pain, and improved quality of life for patients undergoing THR and TKR. Furthermore, preoperative exercise and education interventions were associated with a reduction in the length of hospital stay, postoperative complications, and the need for rehabilitation after surgery. The study suggests that preoperative exercise and education interventions are effective in improving the outcomes of patients undergoing THR and TKR.
Exercises for Knee Prehabilitation
A knee prehabilitation program typically includes a combination of exercises designed to improve muscle strength, range of motion, and balance. Here are some exercises that can be incorporated into a prehabilitation program:
Quadriceps sets: Sit on a chair or lie on your back with your legs straight. Tighten the muscles in the front of your thigh and hold for a few seconds. Relax and repeat for 10-15 repetitions.
Straight leg raises: Sit on a chair with your back straight and your feet on the floor. Lift one leg off the floor, keeping it straight, and hold for a few seconds. Lower your leg and repeat for 10-15 repetitions on each leg.
Hamstring curls: Stand with your feet shoulder-width apart and a chair in front of you for support. Bend one knee and bring your heel towards your buttocks. Hold for a few seconds and then lower your foot. Repeat for 10-15 repetitions on each leg.
Heel slides: Lie on your back with your knees bent and your feet flat on the floor. Slowly slide one foot along the floor towards your buttocks, keeping your heel on the ground. Hold for a few seconds and then slide your foot back to the starting position. Repeat for 10-15 repetitions on each leg.
Terminal knee extension: Sit on a chair and place a rolled-up towel or small pillow under your knee. Straighten your knee and hold for a few seconds. Lower your foot and repeat for 10-15 repetitions on each leg.
Wall squats: Stand with your back against a wall and your feet shoulder-width apart. Slide down the wall, bending your knees to a 90-degree angle. Hold for a few seconds and then slide back up the wall. Repeat for 8-12 repetitions.
Step-ups: Stand in front of a step or stair with your feet hip-width apart. Step up with one foot and then bring the other foot up to the same level. Step back down with one foot and then the other. Repeat for 8-12 repetitions on each leg.
Balancing exercises: Stand with your feet hip-width apart and your arms at your sides. Lift one foot off the ground and balance on the other foot for 30-60 seconds. Repeat on the other foot.
These exercises should be performed under the guidance of a qualified healthcare professional who can customise the program to your needs and monitor your progress. The duration, intensity and exercises included in the program may vary depending on your fitness level and the time available before surgery. It's important to note that prehabilitation is a rather important component of a comprehensive treatment plan.
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Moyer, R., Ikert, K., Long, K., & Marsh, J. (2017). The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. JBJS reviews, 5(12), e2.
Wang, D., Wu, T., Li, Y., Jia, L., Ren, J., & Yang, L. (2021). A systematic review and meta-analysis of the effect of preoperative exercise intervention on rehabilitation after total knee arthroplasty. Ann Palliat Med, 10(10), 10986-96.
