Preoperative High-Intensity Strength Training and Outcomes After Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Context: Preoperative and postoperative strength training is beneficial for outcomes of total knee arthroplasty (TKA). However, the effect of high-intensity strength training is not well understood. Objective: This systematic review and meta-analysis aimed to determine the effects of preoperative high-intensity strength training on TKA outcomes. Data Sources: PubMed, EMBASE, and Cochrane CENTRAL were searched up to December 18, 2023. Study Selection: Randomized controlled trials and cohort studies evaluating the effect of preoperative high-intensity strength training after TKA were eligible. Study Design: Systematic review and meta-analysis. Level of Evidence: Level II, systematic review and meta-analysis of randomized controlled trials and cohort studies. Data Extraction: Evaluated outcomes consisted of Timed Up and Go (TUG) test, the 6-minute walk test (6MWT), stair test, range of motion (ROM) flexion, Short Form Health Survey (SF-36) scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and the Knee Injury and Osteoarthritis Outcome Score for Activities of Daily Living (KOOS-ADL). These were compared between the intervention and control groups using pooled standardized mean differences. The quality of the studies was appraised using the Risk of Bias in Nonrandomized Studies by Interventions (ROBINS-I) and the Cochrane Collaboration tool. Results: Seven studies, comprising 419 patients in total, were included. The meta-analysis showed that the preoperative high-intensity strength training group (intervention group) exhibited statistically significant improvements compared with the control group in 6MWT (pooled standardized mean difference pSMD = 0.73; 95% CI, 0.04 to 1.41), ROM flexion (pSMD = 0.40; 95% CI, 0.08 to 0.72), SF-36 (pSMD = 1.54; 95% CI, 0.32 to 2.75), and WOMAC (pSMD = −0.78, 95% CI, −1.22 to −0.34). Conclusion: Preoperative high-intensity strength training as the prehabilitation programs for patients scheduled for TKA lead to better postoperative recovery, enhanced physical function, and improved quality of life.