Impact of Prehabilitation in Total Knee Replacement

Recovery post Total Knee Replacement Surgery ((TKA) has been a subject of interest. In a
study of 379 patients who had hip or knee replacement surgery, it was reported that at 6
months post-surgery patients with better baseline function had superior functional ability
and less pain than patients with lower function at baseline. Another study of 276 patients
undergoing TKA reported that pre-operative joint function was a predictor of joint function
and overall function at 6 months post-surgery. These findings suggest that prehabilitation
to increase functional ability prior to TKA may have a positive effect in recovering
post-surgery. In a randomized control trial of patients receiving TKA, the group receiving
an Exercise Program (prehabilitation) made significant improvements in performance from
baseline to before surgery, and at 1 and 3 months post surgery. For the group that did not
receive the Exercise Program pre-surgery, significant improvement did not occur until 3
months post surgery. The overall objective of the proposed single-blinded randomized
controlled trial is to demonstrate that a well designed prehabilitation program for patients
receiving TKA surgery will significantly improve outcomes related to pain and function and
may reduce utilization of health care services post surgery.

In this randomized control trial we hypothesize that the group of participants who receive a
prehabilitation Exercise Program will recover quicker than patients who do not receive the
Exercise Program based on several measures of performance including pain, quadriceps
strength, range of motion and quality of life.

Inclusion Criteria:

- Patients scheduled to undergo unilateral TKA surgery

- Ambulatory

- Community dwelling (living at home)

- Able to participate in moderate intensity exercise

- American Society of Anesthesiologists Physical Status Classification(ASA) 1 - 3

- Speaks English

Exclusion Criteria:

- Patients who are planning a second surgery of the lower limbs during the six months
post-surgery

- Have the effect of peripheral vascular disease or stroke on walking