News from the College of Education & Human Development

Patients Can Be Better Prepared for Knee Surgery with Prehabilitation

January 31, 2011 in College News, Faculty Highlights

An exercise program designed for patients with severe knee arthritis can improve strength and functional ability before knee replacement surgery, according to recent report in The Journal of Strength and Conditioning Research.

The study, led by University of Louisville researchers Ann Swank, Ph.D., CSCS, College of Education and Human Development, Department of Health and Sport Sciences, and Robert Topp, Ph.D., R.N., School of Nursing,
found gains from exercise before knee replacement or prehabilitation may translate into improved recovery after surgery.

“We designed this program to be easily transferred to a home environment,” Swank said. “It is very possible for many patients preparing for knee replacement surgery to participate in this exercise program and experience increased strength and functionality in advance of surgery.”

The study included 71 patients scheduled for knee replacement surgery because of severe osteoarthritis that could not be managed with pain medications. Osteoarthritis of the knee is a very common condition in older adults, causing pain and gradual declines in the ability to perform everyday tasks. When pain becomes so severe that medications no longer provide relief, knee replacement surgery is the only option. By that time, reduced leg strength may be present for several years—not only decreasing functional ability, but increasing the risk of falls.

One group of participants was randomly assigned to a comprehensive prehabilitation program, consisting of light resistance training, flexibility and step exercise, and light walking.

Patients in this “pre-rehab” group exercised three times per week, in the clinic and at home, for four to eight weeks before knee replacement surgery. Patients in the comparison group received standard preoperative care, with instructions to continue their usual activities. The two groups were compared for knee strength and performance on standard functional tests.

When tested one week before surgery, patients who went through the prehabilitation program showed improvements in several areas. In particular, they had a ten percent increase in extension strength in the leg scheduled for knee replacement. In contrast, the comparison group had a ten percent decrease in extension strength.

Prehabilitation was also associated with improvement in some functional tests, including the ability to get up from a chair and to climb a set of stairs. Other functional tests, such as walking speed and going downstairs, showed no significant improvement.

In addition, patients in the prehabilitation group also had less pain when performing the functional tests. For patients receiving standard care, performance on some functional tests actually decreased in the weeks before surgery—possibly reflecting increased pain scores.

The results show significant improvements in strength and functioning in the weeks before knee replacement surgery. Strengthening of the leg undergoing knee replacement may be a particularly important factor—exercise may reduce the strength imbalance between legs, therefore contributing to the functional improvement. The researchers do note that even with exercise, the surgical leg remains significantly weaker than the other leg.

Previous studies have evaluated exercise programs to improve leg strength and functional ability before knee replacement surgery, but with limited success.

Although the study did not compare postoperative recovery, increases in leg strength and performance of functional tasks before knee replacement surgery may result in improved postoperative recovery because preoperative performance of functional tasks has been shown to be a predictor of postoperative performance of functional tasks, Swank said.

“The next step in this research is to determine whether this comprehensive prehabilitation exercise program translates to a savings in healthcare dollars,” Topp said. “For example, reducing the number of days a patient stays in the hospital or reducing the number of physical therapy sessions.”

Several other University of Louisville faculty also contributed to the study, “Prehabilitaion Before Total Knee Arthroplasty Increases Strength and Function in Older Adults With Severe Osteoarthritis.”

Note: The article above is a press release adapted by the UofL Health Sciences Center Communications Office from the information released in the February edition of the Journal of Strength and Conditioning, http://journals.lww.com/nsca-jscr/pages/default.aspx.