Prehabilitation before total knee arthroplasty

Background: Prehabilitation before knee joint replacement surgery is gaining increasing importance due to the rising prevalence of knee osteoarthritis. The aim is to optimize the preoperative condition to improve postoperative recovery and reduce complications. Materials and methods: This review is based on a systematic literature search in the databases Medline, Cochrane Library, and Web of Science on the topic of prehabilitation in knee joint replacement. Results: The current evidence shows heterogeneous results regarding the effectiveness of prehabilitation before knee joint replacement; some studies report improved postoperative outcomes such as reduced pain, increased function, and shorter hospital stays through preoperative training measures, while others found no significant differences. Additional preoperatively modifiable risk factors such as reduced physical fitness, substance abuse, nutritional status, comorbidities, and psychological factors should already be addressed during prehabilitation. Digital therapy and education measures offer a promising solution for the implementation of prehabilitation programs and are well received by patients. Conclusion: Overall, the evidence for preoperative training before knee joint replacement remains heterogeneous. Despite positive indications, evidence on exercise content, duration, frequency, and setting remains incomplete, requiring a critical review of current meta-analyses and systematic reviews. Modern prehabilitation before knee joint replacement should include musculoskeletal training and address preoperative risk factors to improve postoperative outcomes.