"The Effect of a Prehabilitation Exercise Program on Quadriceps Strength for Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Pilot Study"
With the success prehab has had with patients undergoing ACL reconstruction, there has been an increase in interest for prehab with total knee replacements as well. Quad strength has long been linked to functional outcomes following surgery. Given the strength deficits noted after surgery, it's possible improving strength prior to surgery may have an impact on patient outcomes.
This RCT contained a placebo group and a lower body strengthening group. The placebo group performed non-specific upper body exercises, while the lower body group performed 10 minutes of warm-up and a set of exercises. The exercises included: standing calf raise, seated leg press, leg curl, and knee extension.
Following prehab, increases in quadriceps strength, walking speed, and mental health were noted prior to surgery (improvements were noted in the control group as well). However, after surgery there was no difference between the control group and experimental group in these categories. Some potential limitations were a low sample size of 22 participants and a focus on open-kinetic chain exercises. It would be interesting to see the effects closed-kinetic chain exercises would have. While further research in this area is definitely still needed, it may be that prehab is not as pertinent for patients receiving a total knee replacement as compared to those preparing for ACL reconstruction.
McKay C, Prapavessis H, & Doherty T. (2012). The Effect of a Prehabilitation Exercise Program on Quadriceps Strength for Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Pilot Study. PM&R: The Journal of Injury, Function and Rehabilitation, 4(9), 647-656.