Effectiveness of Preoperative Rehabilitation Compared With Usual Care in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

Abstract

To determine the efficacy of preoperative rehabilitation on postoperative outcomes after total knee arthroplasty (TKA) and to compare home-based telerehabilitation with clinic-based approaches. PubMed, Embase, Web of Science, and Cochrane databases were searched from inception through July 2025 following PRISMA 2020 guidelines. Randomized controlled trials comparing preoperative rehabilitation with standard care for patients with TKA were included. Two independent reviewers performed screening with a third resolving disagreements. Standardized mean differences (SMD) and weighted mean differences with 95% CI were calculated using random-effects models. Outcomes were stratified by follow-up period and intervention type. Risk of bias and evidence quality were assessed using Cochrane and Grading of Recommendations, Assessment, Development, and Evaluation approaches. Twenty-nine trials encompassing 2157 participants fulfilled our inclusion criteria. Preoperative rehabilitation yielded significant improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-function scores at mid-term (SMD, -1.21; 95% CI, -2.14 to -0.28; P=.011) and long-term follow-up (SMD, -0.47; 95% CI, -0.90 to -0.04; P=.033). Similarly, WOMAC-pain scores demonstrated significant mid-term improvement (SMD, -0.81; 95% CI, -1.35 to -0.27; P=.003). Home-based telerehabilitation consistently outperformed clinic-based approaches across most outcome measures. Although clinic-based rehabilitation occasionally produced larger point estimates (SMD, -1.06; 95% CI, -2.08 to -0.04; P=.041 for WOMAC-function), home-based interventions demonstrated superior overall effectiveness with more stable results (WOMAC-function: SMD, -0.65; 95% CI, -1.17 to -0.13; P=.014; WOMAC-pain: SMD, -0.77; 95% CI, -1.52 to -0.03; P=.005). Although considerable heterogeneity persisted throughout our analyses (I²>75%), extensive sensitivity testing validated the robustness of treatment effects across all measured outcomes. Overall evidence quality reached moderate levels, with heterogeneity and inherent blinding constraints representing the primary limitations. Preoperative rehabilitation enhances functional recovery and pain relief after TKA, with benefits primarily during the mid-term phase. Home-based telerehabilitation demonstrated superior efficacy compared with clinic-based approaches, suggesting a paradigm shift in perioperative TKA management. The consistent benefits across diverse interventions support the general principle of preoperative conditioning despite methodological heterogeneity.