gms | German Medical Science

Objectives: Because of the burden of osteoarthritis and total joint replacement (TJR) in our aging society, treatment has been economized and streamlined in the recent past. Through constant improvement, length of stay (LOS) and post-operative pain and outcome have improved. One tool is pre-operative patient-education, where patients are prepared for the post-operative procedure. While this is known to have enhancing characteristics on LOS and outcome, little is known about the influence of pre-operative physiotherapy/prehabilitation (PT), where patients can train specific motion sequences required for TJR in advance (e.g. ambulation with assistive devices, transfer in and out from bed, etc.), which could simplify early rehabilitation and increase functional outcome. We therefore hypothesized that pre-operative PT leads to (I) a shortened LOS, (II) reduced pain levels, and (III) better functional outcome 3-, 6- and 12-months post-operatively.

Methods: Data was obtained via a multicenter, cross-sectoral, prospective study design (the PROMISE Trial). Pre-operative PT was conducted with a registered physiotherapist; sessions lasted approximately 20 to 30 minutes. LOS was evaluated at hospital discharge, pain was assessed pre- and post-operative using the EQ-5D VAS-Score. Pre-operative joint function was evaluated 1-8 weeks prior to surgery, post-operative functional outcome was evaluated 3-, 6- and 12-months post-operative using HOOS- and KOOS-12. Post-operative rehabilitation was standardized in all participating centers. Uni- and multivariate Log-linear regression and t-test were carried out to show the influence of prehabilitation on LOS, VAS, and HOOS-12/KOOS-12 score pre- and 3-, 6- and 12-month post-operative.

Results: 791 patients were eligible for analysis, 458 patients (57.9%) had done pre-operative PT. Mean age was 66.6 years, 44.4% were male. The ratio of total hip replacement to total knee replacement was half divided (50.4% to 49.6%). Mean LOS was 5.4 days.

Influence of PT on LOS showed no significance. Evaluation regarding pain without stress was significant for VAS score at 12 months postoperative in the PT group (p= .003). Assessing pain under stress, multivariate analysis revealed significant reduction in VAS absolute score on hospital discharge (p= <.001) and at 12 months post-operative (p= <.013) in the PT group. Data showed higher functional scores in the PT group at all post-operative survey-points in total hip arthroplasty, but did not reach significance. When stratified for influence on KOOS-12, multivariate analysis showed significant higher scores in the PT group at all post-operative survey-points (Table 1 [Tab. 1]).

Conclusion: Prehabilitation is effective at reducing post-operative pain in TJR and increasing post-operative functional outcome in total knee arthroplasty up to 12 months after surgery. It did not significantly affect functional outcome of total hip arthroplasty or reduce LOS in TJR.