Prehabilitation before Total Knee and Hip Arthroplasty in Older Adults: A Narrative Review

Background: This review aims to investigate the components of prehabilitation for older surgical patients based on current evidence, while evaluating its impact on clinical outcomes, functional independence and postoperative quality of life within this vulnerable group. Review Text: A systematic search of PubMed was conducted for studies published between 2020 and 2026 using the keywords “prehabilitation”, “total knee arthroplasty”, “total hip arthroplasty”, “older adults”, “preoperative exercise”, and “postoperative outcomes” without language or geographic restrictions. Eligible studies focused on preoperative interventions for adults undergoing hip or knee arthroplasty and reported functional, clinical, or quality of life outcomes. Systematic reviews, meta-analyses, randomised controlled trials and narrative reviews were included, while conference abstracts, case reports and studies lacking extractable data or relevance to older adults were excluded. Current evidence supports multimodal programmes combining muscle strengthening, aerobic conditioning, balance, flexibility, breathing exercises and patient education. These interventions are associated with reduced postoperative pain, shorter hospital stays and a faster return to functional independence. Conclusion: The preoperative period represents a valuable window for personalised, multidisciplinary prehabilitation. Such programmes enhance physiological resilience and patient awareness, leading to improved postoperative recovery quality and higher patient satisfaction.