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Prehabilitation Before Total Knee Arthroplasty Increases Strength and Function in Older Adults With Severe Osteoarthritis

Swank, Ann M1; Kachelman, Joseph B1; Bibeau, Wendy2; Quesada, Peter M3; Nyland, John4; Malkani, Arthur5; Topp, Robert V6

Journal of Strength & Conditioning Research: February 2011 - Volume 25 - Issue 2 - pp 318-325
doi: 10.1519/JSC.0b013e318202e431
Original Research
Press Release

Swank, AM, Kachelman, JB, Bibeau, W, Quesada, PM, Nyland, J, Malkani, A, and Topp, RV. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res 25(2): 318-325, 2011-Preparing for the stress of total knee arthroplasty (TKA) surgery by exercise training (prehabilitation) may improve strength and function before surgery and, if effective, has the potential to contribute to postoperative recovery. Subjects with severe osteoarthritis (OA), pain intractable to medicine and scheduled for TKA were randomized into a usual care (UC) group (n = 36) or usual care and exercise (UC + EX) group (n = 35). The UC group maintained normal daily activities before their TKA. The UC + EX group performed a comprehensive prehabilitation program that included resistance training using bands, flexibility, and step training at least 3 times per week for 4-8 weeks before their TKA in addition to UC. Leg strength (isokinetic peak torque for knee extension and flexion) and ability to perform functional tasks (6-minute walk, 30 second sit-to-stand repetitions, and the time to ascend and descend 2 flights of stairs) were assessed before randomization at baseline (T1) and 1 week before the subject's TKA (T2). Repeated-measures analysis of variance indicated a significant group by time interaction (p < 0.05) for the 30-second sit-to-stand repetitions, time to ascend the first flight of stairs, and peak torque for knee extension in the surgical knee. Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA. Short term (4-8 weeks) of prehabilitation was effective for increasing strength and function for individuals with severe OA. The program studied is easily transferred to a home environment, and clinicians working with this population should consider prehabilitation before TKA.

1Exercise Physiology Laboratory, University of Louisville, Louisville, Kentucky; 2School of Public Health, University of Maryland, Maryland; 3Speed School Department of Engineering, University of Louisville, Louisville, Kentucky; 4Department of Orthopedics, University of Louisville, Louisville, Kentucky; 5School of Medicine, University of Louisville, Louisville, Kentucky; 6School of Nursing, University of Louisville, Louisville, Kentucky

Address correspondence to Dr. Ann M. Swank,

© 2011 National Strength and Conditioning Association