Preoperative exercise can benefit THA and TKA patients

Preoperative exercise regime reduces placement into a rehab facility after discharge.

While exercise is often used successfully in treating postop joint replacement patients, a presurgical exercise regime can be beneficial, too, according to a study published in Arthritis Care & Research.

The study looked at 108 men and women scheduled to have either total hip arthroplasty (THA) or total knee arthroplasty (TKA). Half of the participants undertook land- and water-based exercise activities 3 times a week for 6-weeks immediately prior to surgery.

The exercise focused on strength training, aerobics and flexibility and was tailored for each patient's specific needs. The control-group participants received educational materials. Outcomes were assessed through questionnaires and performance measures, which were examined before intervention, immediately before surgery and at 8 and 26 weeks postop.

The investigators found that at the time of hospital discharge, the exercising patients were more likely to walk more than 50 feet and could go directly home. "We were pleasantly surprised at the discharge statistics," lead author Daniel S. Rooks, ScD of New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School told Orthopedics Today. "Those who exercised decreased their odds of going to a rehab facility by 73%."

The exercising THA patients saw the most improvement in their Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index function scores, with a score of ±2.2, compared to the control group's score of –3.9. The SF-36 physical function score for the exercising THA declined 0.4 and the control groups score decreased by 14.3.

However, researchers did not find any significant difference in prior pain or function in TKA patients, according to the study. Exercising did increase overall preop muscle strength.

Rooks said that appropriate presurgical activity can be safe for patients with OA and can improve function in THA patients.

"With today's society being less active and more sedentary, the idea of needing an exercise intervention to elevate a level of fitness was a logical step," he said. "For those people who did not exercise, their function continued to decline leading up to surgery."

Presurgical exercise also has potential economic benefits allowing more people to go home upon discharge instead of to a rehabilitation facility, Rooks said.

"Many of the things we heard from people was that they just felt more prepared, physically and mentally, for the rehabilitation step after surgery," Rooks said.

The only patients that may not benefit from presurgical exercise are those who have severe physical limitations, where activity would either overstress the area or if they have some other limitation, such as a cardiovascular problem, he said.

However, doctors should be encouraged by these study results - and should also encourage their patients to partake in presurgical physical activity.

For more information:
Rooks DS, Huang J, Bierbaum BE, Bolus SA, et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Care & Research. 2006; 55:700-708.
Daniel S. Rooks, ScD, assistant professor of medicine, department of medicine, Beth Israel Deaconess Medical Center, Nutrition Medicine, FD976, 330 Brookline Ave., Boston, MA 02215; 617-667-2682; drooks@bidmc.harvard.edu.