High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial



The benefits of preoperative training programmes compared with alternative treatment are unclear. The purpose of this study was to evaluate the effectiveness of a high-intensity preoperative resistance training programme in patients waiting for total knee arthroplasty (TKA).


Forty-four subjects (7 men, 37 women) scheduled for unilateral TKA for osteoarthritis (OA) during 2014 participated in this randomized controlled trial. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), a 10-cm visual analogue scale (VAS), isometric knee flexion, isometric knee extension, isometric hip abduction, active knee range of motion and functional tasks (Timed Up and Go test and Stair ascent–descent test) were assessed at 8 weeks before surgery (T1), after 8 weeks of training (T2), 1 month after TKA (T3) and finally 3 months after TKA (T4). The intervention group completed an 8-week training programme 3 days per week prior to surgery.


Isometric knee flexion, isometric hip abduction, VAS, WOMAC, ROM extension and flexion and all the functional assessments were greater for the intervention group at T2, T3 and T4, whereas isometric knee extension was greater for this group at T2 and T4 compared with control.


The present study supports the use of preoperative training in end-stage OA patients to improve early postoperative outcomes. High-intensity strength training during the preoperative period reduces pain and improves lower limb muscle strength, ROM and functional task performance before surgery, resulting in a reduced length of stay at the hospital and a faster physical and functional recovery after TKA. The present training programme can be used by specialists to speed up recovery after TKA.

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Correspondence to Joaquin Calatayud.

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The authors did not receive financial support for this study, and there are no known conflicts of interest associated with this publication that could have influenced its outcome.

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Calatayud, J., Casaña, J., Ezzatvar, Y. et al. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25, 2864–2872 (2017). https://doi.org/10.1007/s00167-016-3985-5

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  • Prehabilitation
  • Osteoarthritis
  • Ageing
  • Resistance training
  • Knee
  • Strength training