Do Pre-operative and Post-operative Rehabilitation Interventions Impact Unicompartmental Knee Arthroplasty Outcomes? A Systematic Review

Unicompartmental knee arthroplasty (UKA) can consistently result in successful outcomes, but unfavorable results can be prevalent when patient variables are not optimized for success. One variable that has significant impact on outcomes following total knee arthroplasty involves preoperative physical rehabilitation or “prehab”. However, the effects of prehab on UKA outcomes have not been comprehensively analyzed. This study was designed to systematically review the peer-reviewed evidence regarding prehab strategies and their impacts on patient outcomes after UKA. A search of the peer-reviewed literature yielded 266 articles eligible for screening, which resulted in 5 articles meeting criteria for systematic review. Taken together, the peer-reviewed literature suggests that prehab consisting of patient education provided by a multidisciplinary healthcare team that includes a physical therapist as well as exercise training have the potential to safely and effectively reduce length of stay and are consistently associated with significant improvements in patient-reported pain and function for up to 5 years following UKA. These findings fall in line with the robust evidence available regarding the benefits of prehab for TKA and other elective orthopaedic surgeries, including significant mental, behavioral, and functional improvements that enhance patient-reported outcomes, satisfaction, quality of life, and cost-effectiveness. Unfortunately, the small number of studies available in conjunction with the limited level of evidence and moderate to high risk of bias prevent conclusions regarding the impacts and cost effectiveness of these interventions and prohibit evidence-based recommendations regarding shifts in practice. However, in conjunction with the robust evidence regarding multidisciplinary health care team impacts on patient outcomes following elective orthopaedic surgeries, even the limited evidence available provides sufficient proof of safety such that prehab should be considered for inclusion in comprehensive-care UKA studies moving forward