OBJECTIVE: To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surgery. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: The authors searched the MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science, and Scopus databases from their inception until March 2022. STUDY SELECTION CITERIA: The authors included peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation. DATA SYNTHESIS: We assessed bias using the Cochrane Risk-of-Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardized mean differences (Hedges' g) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low to very low certainty of evidence favored prehabilitation over no intervention for improving knee functioning before (g = 1.23; 95% CI 0.49 to 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month, g = 0.90; 95% CI 0.18 to 1.61; mid-term: 6 weeks to 3 months, g = 0.45; 95% CI 0.06 to 0.84). There were no significant between-group differences at long-term follow-up (6-12 months, g = 0.07; 95% CI -0.17 to 0.30). CONCLUSION: There was low to very low certainty of evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive.

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