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  1. Shoemaker, Michael J. DPT, PT, PhD, GCS
  2. Gibson, Cortney DPT, PT
  3. Saagman, Sarah DPT, PT


Introduction: The purpose of this article was to systematically review all studies related to the efficacy of preoperative exercise for patients undergoing total knee arthroplasty and to consider issues not previously addressed by previous systematic reviews.


Methods: Studies found by searching CINAHL, PubMed, and ProQuest databases were included in the review if the preoperative intervention contained exercise for patients undergoing total knee arthroplasty. Article selection, data extraction, and evaluation of methodological rigor quality were performed by 2 independent reviewers. Sixteen studies met the inclusion criteria and were used in this review.


Results: No consistent effects of preoperative exercise intervention were found among the 17 included studies. There was a lack of consistency among studies with regard to the use of resource utilization metrics and clinical outcome measures, insufficient dosing of nonfunctional exercises, and short postoperative follow-up periods of 3 months or less. Most important, previous studies have failed to investigate the impact of preoperative rehabilitation in patients at risk of poor outcome.


Conclusions: Several important deficiencies in the literature preclude definitive conclusions about the efficacy of preoperative exercise in patients undergoing total knee arthroplasty. Sampling strategies and inclusion criteria should focus on individuals at risk of poor outcome rather than typically recovering individuals.