Rehabilitation strategies for optimisation of functional recovery after major joint replacement

Exercise‐based interventions applied before and after total hip and knee arthroplasty (THA and TKA, respectively) have been investigated for a number of years, based on the assumption that they will enhance post‐operative recovery. Although recent studies suggest that high‐volume, pre‐operative exercise may enhance post‐operative recovery after TKA, studies of post‐operative exercise‐based interventions, have not found superiority of one exercise regime over another. It seems, however, that post‐operative, exercise‐based, rehabilitation is superior to no or minimal rehabilitation after THA and TKA. The goal of this commentary is to summarize recent evidence for the efficacy of different peri‐operative exercise‐based interventions to enhance recovery after THA and TKA, and to propose new strategies to further enhance post‐operative recovery. There is a major need to improve functional recovery after THA and TKA. We propose a strategy of “enriched” trials where specific rehabilitation interventions are applied to different patients based on, for example, their expectations for post‐operative recovery, willingness to undertake exercise and physical activity, and pre‐operative functional performance.