Advertisement

Does Exercise Reduce Pain and Improve Physical Function Before Hip or Knee Replacement Surgery? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Published:September 06, 2012DOI:https://doi.org/10.1016/j.apmr.2012.08.211

      Abstract

      Objective

      To investigate the preoperative effects of exercise-based interventions on pain and physical function for people awaiting joint replacement surgery of the hip or knee.

      Data Sources

      Four computer databases (CINAHL, MEDLINE, Embase, and Cochrane Library) were searched until July 4, 2012. Search terms included knee, hip, joint replacement, arthroplasty, physiotherapy, physical therapy, exercise, hydrotherapy, rehabilitation, and preoperative. Reference lists of retrieved articles were also screened.

      Study Selection

      Randomized or quasi-randomized studies comparing an exercise-based intervention with a no-intervention group for people awaiting hip or knee joint replacement surgery were included. Outcomes were pain and physical function including self-reported function, walking speed, and muscle strength. One of 2 reviewers determined that 18 studies met the inclusion criteria.

      Data Extraction

      The methodologic quality of each study was independently assessed by 2 reviewers using the PEDro scale, and a final PEDro score was determined by discussion and consensus between the reviewers. Participants’ characteristics, content and design of the interventions, and data for quantitative synthesis were extracted by 1 reviewer.

      Data Synthesis

      For participants awaiting knee replacement surgery, quantitative data synthesis found no significant differences between the exercise and no-intervention groups for pain, self-reported function, walking speed, or muscle strength. For participants awaiting hip replacement surgery, quantitative data synthesis found a significant difference between the groups, with standardized mean differences (SMDs) indicating a medium-sized effect in favor of intervention for both pain (SMD=.45; 95% confidence interval .15–.75) and self-reported function (SMD=.46; 95% confidence interval .20–.72).

      Conclusions

      Exercise-based interventions can reduce pain and improve physical function for people awaiting hip replacement surgery but not knee replacement surgery.

      Keywords

      List of abbreviations:

      CONTENT (Consensus on Therapeutic Exercise Training), SMD (standardized mean difference), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • MacWilliam C.H.
        • Yood M.U.
        • Verner J.J.
        • McCarthy B.D.
        • Ward R.E.
        Patient-related risk factors that predict poor outcome after total hip replacement.
        Health Serv Res. 1996; 31: 623-638
        • Jones C.A.
        • Voaklander D.C.
        • Johnston W.C.
        • Suarez-Almazor M.E.
        Health related quality of life outcomes after total hip and knee arthroplasties in a community-based population.
        J Rheumatol. 2000; 27: 1745-1752
        • Brownlow H.C.
        • Benjamin S.
        • Andrew J.G.
        • Kay P.
        Disability and mental health of patients waiting for total hip replacement.
        Ann R Coll Surg Engl. 2001; 83: 128-133
        • Hirvonen J.
        • Blom M.
        • Tuominen U.
        • et al.
        Health-related quality of life in patients waiting for major joint replacement: a comparison between patients and population controls.
        Health Qual Life Outcomes. 2006; 4: 3
        • Bachmeier C.J.
        • March L.M.
        • Cross M.J.
        • et al.
        A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery.
        Osteoarthritis Cartilage. 2001; 9: 137-146
        • Callahan C.M.
        • Drake B.G.
        • Heck D.A.
        • Dittus R.S.
        Patient outcomes following tricompartmental total knee replacement: a meta-analysis.
        JAMA. 1994; 271: 1349-1357
        • Williams J.
        • Llewellyn Thomas H.
        • Arshinoff R.
        • Young N.
        • Naylor C.
        The burden of waiting for hip and knee replacements in Ontario. Ontario Hip and Knee Replacement Project Team.
        J Eval Clin Pract. 1997; 3: 59-68
        • Ackerman I.N.
        • Bennell K.L.
        • Osborne R.H.
        Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study.
        BMC Musculoskelet Disord. 2011; 12: 108
        • Fortin P.R.
        • Clarke A.E.
        • Joseph L.
        • et al.
        Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery.
        Arthritis Rheum. 1999; 42: 1722-1728
        • Jones C.A.
        • Voaklander D.C.
        • Suarez-Alma M.E.
        Determinants of function after total knee arthroplasty.
        Phys Ther. 2003; 83: 696-706
        • Fransen M.
        • Crosbie J.
        • Edmonds J.
        Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.
        J Rheumatol. 2001; 28: 156-164
        • Zhang W.
        • Moskowitz R.W.
        • Nuki G.
        • et al.
        OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines.
        Osteoarthritis Cartilage. 2008; 16: 137-162
        • Zhang W.
        • Nuki G.
        • Moskowitz R.W.
        • et al.
        OARSI recommendations for the management of hip and knee osteoarthritis, part III: changes in evidence following systematic cumulative update of research published through January 2009.
        Osteoarthritis Cartilage. 2010; 18: 476-499
        • Fransen M.
        • McConnell S.
        Exercise for osteoarthritis of the knee.
        Cochrane Database Syst Rev. 2008; Issue 4: CD004376https://doi.org/10.1002/14651858
        • Fransen M.
        • McConnell S.
        • Hernandez-Molina G.
        • Reichenbach S.
        Exercise for osteoarthritis of the hip.
        Cochrane Database Syst Rev. 2009; Issue 3: CD007912https://doi.org/10.1002/14651858
        • Ackerman I.N.
        • Bennell K.L.
        Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.
        J Physiother. 2004; 50: 25-30
        • Coudeyre E.
        • Jardin C.
        • Givron P.
        • Ribinik P.
        • Revel M.
        • Rannou F.
        Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines.
        Annales de Réadaptation et de Médecine Physique. 2007; 50: 189-197
        • Ackerman I.N.
        • Bennell K.L.
        Current Australian practice in pre-operative physiotherapy prior to total knee replacement surgery.
        Physiotherapy. 2004; 90: 176-182
        • Sherrington C.
        • Herbert R.D.
        • Maher C.G.
        • Moseley A.M.
        PEDro: a database of randomized trials and systematic reviews in physiotherapy.
        Man Ther. 2000; 5: 223-226
        • Maher C.G.
        • Sherrington C.
        • Herbert R.D.
        • Moseley A.M.
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Foley N.C.
        • Teasell R.W.
        • Bhogal S.K.
        • Speechley M.R.
        Stroke rehabilitation evidence-based review: methodology.
        Top Stroke Rehabil. 2003; 10: 1-7
        • Valkenet K.
        • van de Port I.G.L.
        • Dronkers J.J.
        • de Vries W.R.
        • Lindeman E.
        • Backx F.J.G.
        The effects of preoperative exercise therapy on postoperative outcome: a systematic review.
        Clin Rehabil. 2010; 25: 99-111
        • Cohen J.
        Statistical power analysis for the behavioural sciences. Revised edition.
        2nd ed. Academic Pr, New York1977
        • Review Manager (RevMan)
        [Computer program]. Version 5.1.
        The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen2011
        • Hoogeboom T.J.
        • Dronkers J.J.
        • van den Ende C.H.
        • Oosting E.
        • van Meeteren N.L.
        Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial.
        Clin Rehabil. 2010; 24: 901-910
        • Oosting E.
        • Jans M.P.
        • Dronkers J.J.
        • et al.
        Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial.
        Arch Phys Med Rehabil. 2012; 93: 610-616
        • Angst F.
        • Aeschlimann A.
        • Steiner W.
        • Stucki G.
        Responsiveness of the WOMAC osteoarthritis index as compared with the SF36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention.
        Ann Rheum Dis. 2001; 60: 834-840
        • Nilsdotter A.
        • Lohmander L.S.
        • Klassbo M.
        • Roos E.
        Hip disability and Osteoarthritis Outcome Score (HOOS)—validity and responsiveness in total hip replacement.
        BMC Musculoskelet Disord. 2003; 4: 10
        • D’Lima D.D.
        • Colwell Jr., C.W.
        • Morris B.A.
        • Hardwick M.E.
        • Kozin F.
        The effect of preoperative exercise on total knee replacement outcomes.
        Clin Orthop. 1996; 326: 174-182
        • Aoki O.
        • Tsumura N.
        • Kimura A.
        • Okuyama S.
        • Takikawa S.
        • Hirata S.
        Home stretching exercise is effective for improving knee range of motion and gait in patients with knee osteoarthritis.
        J Phys Ther Sci. 2009; 21: 113-119
        • Hozo S.P.
        • Djulbegovic B.
        • Hozo I.
        Estimating the mean and variance from the median, range, and the size of a sample.
        BMC Med Res Methodol. 2005; 5: 13
        • Winter S.V.
        • Burch D.
        Effects of preoperative water exercise on total knee replacement patients.
        J Aquat Phys Ther. 2000; 8: 12-17
        • Gstoettner M.
        • Raschner C.
        • Dirnberger E.
        • Leimser H.
        • Krismer M.
        Preoperative proprioceptive training in patients with total knee arthroplasty.
        Knee. 2011; 18: 265-270
        • Wijgman A.J.
        • Dekkers G.H.
        • Waltje E.
        • Krekels T.
        • Arens H.J.
        [No positive effect of preoperative exercise therapy and teaching in patients to be subjected to hip arthroplasty].
        [Dutch] Ned Tijdschr Geneeskd. 1994; 138: 949-952
        • Gill S.D.
        • McBurney H.
        • Schulz D.L.
        Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial.
        Arch Phys Med Rehabil. 2009; 90: 388-394
        • Topp R.
        • Swank A.M.
        • Quesada P.M.
        • Nyland J.
        • Malkani A.
        The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty.
        Phys Med Rehabil. 2009; 1: 729-735
        • Swank A.M.
        • Kachelman J.B.
        • Bibeau W.
        • et al.
        Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis.
        J Strength Cond Res. 2011; 25: 318
        • Wang A.W.
        • Gilbey H.J.
        • Ackland T.R.
        Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty: a randomized, controlled trial.
        Am J Phys Med Rehabil. 2002; 81: 801-806
        • Gilbey H.J.
        • Ackland T.R.
        • Wang A.W.
        • Morton A.R.
        • Trouchet T.
        • Tapper J.
        Exercise improves early functional recovery after total hip arthroplasty.
        Clin Orthop. 2003; 408: 193-200
        • Nunez M.
        • Nunez E.
        • Segur J.M.
        • et al.
        The effect of an educational program to improve health-related quality of life in patients with osteoarthritis on waiting list for total knee replacement: a randomized study.
        Osteoarthritis Cartilage. 2006; 14: 279-285
        • Weidenhielm L.
        • Mattsson E.
        • Brostrom L.A.
        • Wersall-Robertsson E.
        Effect of preoperative physiotherapy in unicompartmental prosthetic knee replacement.
        Scand J Rehabil Med. 1993; 25: 33-39
        • Borjesson M.
        • Robertson E.
        • Weidenhielm L.
        • Mattsson E.
        • Olsson E.
        Physiotherapy in knee osteoarthrosis: effect on pain and walking.
        Physiother Res Int. 1996; 1: 89-97
        • Rodgers J.A.
        • Garvin K.L.
        • Walker C.W.
        • Morford D.
        • Urban J.
        • Bedard J.
        Preoperative physical therapy in primary total knee arthroplasty.
        J Arthroplasty. 1998; 13: 414-421
        • Beaupre L.A.
        • Lier D.
        • Davies D.M.
        • Johnston D.B.
        The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty.
        J Rheumatol. 2004; 31: 1166-1173
        • Gocen Z.
        • Sen A.
        • Unver B.
        • Karatosun V.
        • Gunal I.
        The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial.
        Clin Rehabil. 2004; 18: 353-358
        • Rooks D.S.
        • Huang J.I.E.
        • Bierbaum B.E.
        • et al.
        Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty.
        Arthritis Rheum. 2006; 55: 700-708
        • Williamson L.
        • Wyatt M.R.
        • Yein K.
        • Melton J.T.K.
        Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement.
        Rheumatology (Oxford). 2007; 46: 1445-1449
        • Evgeniadis G.
        • Beneka A.
        • Malliou P.
        • Mavromoustakos S.
        • Godolias G.
        Effects of pre- or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis.
        J Back Musculoskelet Rehabil. 2008; 21: 161-169
        • Ferrara P.
        • Rabini A.
        • Maggi L.
        • et al.
        Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty.
        Clin Rehabil. 2008; 22: 977-986
        • McKay C.
        • Prapavessis H.
        • Doherty T.
        The effect of a prehabilitation exercise program on quadriceps strength for patients undergoing total knee arthroplasty: a randomized controlled pilot study.
        Phys Med Rehabil. 2012; 4: 647-656
        • Hemels M.E.
        • Vicente C.
        • Sadri H.
        • Masson M.J.
        • Einarson T.R.
        Quality assessment of meta-analyses of RCTs of pharmacotherapy in major depressive disorder.
        Curr Med Res Opin. 2004; 20: 477-484
        • Bennell K.L.
        • Hinman R.S.
        A review of the clinical evidence for exercise in osteoarthritis of the hip and knee.
        J Sci Med Sport. 2011; 14: 4-9
        • Batterham S.
        • Heywood S.
        • Keating J.
        Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes.
        BMC Musculoskelet Disord. 2011; 12: 123
        • Hoogeboom T.J.
        • Oosting E.
        • Vriezekolk J.E.
        • et al.
        Therapeutic validity and effectiveness of preoperative exercise on functional recovery after joint replacement: a systematic review and meta-analysis.
        PLoS ONE. 2012; 7: e38031
        • Garber C.E.
        • Blissmer B.
        • Deschenes M.R.
        • et al.
        American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
        Med Sci Sports Exerc. 2011; 43: 1334-1359
        • Bennell K.L.
        • Egerton T.
        • Pua Y.H.
        • Abbott J.H.
        • Sims K.
        • Buchbinder R.
        Building the rationale and structure for a complex physical therapy intervention within the context of a clinical trial: a multimodal individualized treatment for patients with hip osteoarthritis.
        Phys Ther. 2011; 91: 1525-1541
        • Hulzebos E.H.
        • Helders P.J.
        • Favie N.J.
        • De Bie R.A.
        • Brutel de la Riviere A.
        • Van Meeteren N.L.
        Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial.
        JAMA. 2006; 296: 1851-1857
        • Guyatt G.H.
        • Oxman A.D.
        • Montori V.
        • et al.
        GRADE guidelines: 5. Rating the quality of evidence-publication bias.
        J Clin Epidemiol. 2011; 64: 1277-1282
        • Bellamy N.
        • Kirwan J.
        • Boers M.
        • et al.
        Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis: consensus development at OMERACT III.
        J Rheumatol. 1997; 24: 799-802
      1. Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. Available at: www.cochrane-handbook.org.

        • Altman D.G.
        • Schulz K.F.
        • Moher D.
        • et al.
        The revised CONSORT statement for reporting randomized trials: explanation and elaboration.
        Ann Intern Med. 2001; 134: 663-694
        • Burke D.W.
        • O’Flynn H.
        Primary total knee arthroplasty.
        in: Chapman M.W. Chapman’s orthopaedic surgery. 3rd ed. Lippincott Williams & Wilkins, Philadelphia2001
        • Berry D.J.
        Primary total hip arthroplasty.
        in: Chapman M.W. Chapman’s orthopaedic surgery. Lippincott Williams & Wilkins, Philadelphia2001
        • Shrier I.
        • Feldman D.E.
        • Gaudet M.C.
        • et al.
        Conservative non-pharmacological treatment options are not frequently used in the management of hip osteoarthritis.
        J Sci Med Sport. 2006; 9: 81-86
        • Power J.D.
        • Cott C.A.
        • Badley E.M.
        • Hawker G.A.
        Physical therapy services for older adults with at least moderately severe hip or knee arthritis in 2 Ontario counties.
        J Rheumatol. 2005; 32: 123-129
        • Wallis J.A.
        • Taylor N.F.
        Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery—a systematic review and meta-analysis.
        Osteoarthritis Cartilage. 2011; 19: 1381-1395