Are pre-operative exercise interventions for joint arthroplasty effective at improving peri-operative outcomes: A systematic review and meta-analysis of randomized controlled trials

Evidence on pre-operative physical activity before hip and knee arthroplasty is limited and heterogeneous. Intervention components and behavior change techniques remain underexplored. This review examined the effectiveness of pre-operative physical activity interventions on patient and surgical outcomes in elective hip and knee arthroplasty up to 12 weeks post-surgery. A systematic search of 8 databases up to August 8, 2024 identified randomized controlled trials of physical activity interventions before total hip and knee arthroplasty. Quality of evidence was evaluated with Grading of Recommendations, Assessment, Development and Evaluation framework. Random-effects models were used for meta-analyses. The Template for Intervention Description and Replication (TIDieR) was used for detailing the included interventions. Forty trials were included. Significant mean differences in favor of the intervention groups were found at pre- and post-surgery in 4 outcomes: health-related quality of life (Knee pre-surgery SMD = -0.5, 95%CI: -0.1to -0.1 and Hip and Knee post-surgery SMD = -0.4, 95%CI: -0.6 to -0.1), pain (Hip and Knee pre-surgery SMD = -0.4, 95%CI: -0.6 to -0.1 and Knee post-surgery SMD = -0.3, 95%CI: -0.6 to -0.1), function (Hip and Knee pre-surgery SMD = -0.5, 95%CI: -0.8 to -0.2 and Knee post-surgery SMD = -0.6, 95%CI: -1 to -0.2), and timed-up-and-go (Hip and Knee MD = -1.2, 95%CI -2.0 to -0.3 and Hip and Knee MD = -1.3, 95%CI: -1.7 to -0.8). Half of the interventions reported over 75% of the TIDieR items, while behavior change techniques reporting was limited. Pre-operative exercise improves health-related quality of life, pain, and function pre- and post-surgery in elective hip and knee arthroplasty. Standardized reporting is needed for establishing effective intervention components.