Intervenciones de prehabilitación en la población sometida a Artroplastia Total de Rodilla: revisión de alcance
DOI:
https://doi.org/10.33194/rper.2026.44140Palabras clave:
Enfermería de rehabilitación, Prehabilitación, Artroplastia total de rodilla, Scoping review, Rehabilitación preoperatoria, Cuidados de enfermeríaResumen
Introducción: La artroplastia total de rodilla (ATR) constituye una de las intervenciones quirúrgicas con mayor prevalencia en el tratamiento de la gonartrosis. En este contexto, surge el concepto de prehabilitación como el proceso orientado a potenciar la capacidad funcional y psicológica de la persona en el período preoperatorio. Este estudio tiene como objetivo mapear las intervenciones de prehabilitación implementadas en personas sometidas a artroplastia total de rodilla, identificando los dominios de intervención, los contextos de aplicación y los principales resultados evaluados.
Metodología: La scoping review siguió el enfoque metodológico propuesto por el Joanna Briggs Institute (JBI). La búsqueda se realizó entre septiembre y octubre de 2024 en las bases de datos MEDLINE (vía PubMed) y CINAHL (vía EBSCO), utilizando Google Académico como fuente complementaria para la identificación de literatura gris. Se incluyeron estudios con adultos sometidos a artroplastia total de rodilla y con intervenciones de prehabilitación implementadas en el período preoperatorio. Solo se consideraron estudios publicados en inglés, portugués y español. La selección de los estudios siguió el diagrama de flujo PRISMA-ScR.
Resultados: Se incluyeron treinta estudios. El contexto hospitalario fue predominante (73%). En cuanto a los dominios de intervención, el dominio musculoesquelético fue el más frecuente (83%), seguido del componente educativo (40%) y del dominio cardiorrespiratorio (27%). Los principales resultados evaluados incluyeron dolor, funcionalidad, calidad de vida y tiempo de hospitalización.
Conclusión: La evidencia demuestra una predominancia de intervenciones centradas en el entrenamiento musculoesquelético, con limitada estandarización y escasa integración multimodal. El mapeo realizado refuerza la necesidad de avanzar hacia programas con enfoques más estructurados y multimodales.
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1. Resolução do Conselho de Ministros n.º 14/2024 de 12 de janeiro. Em Diário da Républica: 1ª Série, nº9, 31-78. Disponível em: https://files.diariodarepublica.pt/1s/2024/01/00900/0003100078.pdf
2. Esquenazi, D, Silva, S R, Guimarães, AM. Aspectos fisiopatológicos do envelhecimento humano e quedas em idosos. Revista HUPE [Internet]. 31 março 2014 [citado 2025 Fev 21]; 13(2):11-20. Disponível em: https://www.e-publicacoes.uerj.br/index.php/revistahupe/article/view/10124 DOI:10.12957/rhupe.2014.10124
3. Branco, JC, Rodrigues, AM, Gouveia, N, Eusébio, M, Ramiro, S, Machado, PM, et al. Prevalence of rheumatic and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt - a national health survey. Rheumatic&Musculoskeletal Diseases [Internet]. 19 Janeiro 2016 [citado 2025 Fev 21]; 2(1): 1-12. Disponível em : https://rmdopen.bmj.com/content/2/1/e000166 DOI: http://doi.org/10.1136/rmdopen-2015-000166
4. Forte LRG. Fatores de risco de infeção do local cirúrgico após artroplastia do joelho [dissertação de mestrado na Internet]. Lisboa: Escola Superior de Saúde Cruz Vermelha; 2024 [citado 2025 fev 21]. Disponível em: https://comum.rcaap.pt/bitstream/10400.26/51410/1/Relat%C3%B3rio%20Final%20de%20Est%C3%A1gio.pdf
5. Oliveira TF. Caracterização e avaliação da gestão da terapêutica da dor em doentes com osteoartrose do joelho em Portugal [dissertação de mestrado na Internet]. Lisboa: Universidade de Lisboa, Faculdade de Medicina; 2019 [citado 2025 fev 21]. Disponível em: http://hdl.handle.net/10451/39722
6. Conselho Nacional de Saúde. Plano Nacional de Saúde 2020-2030 [Internet]. Lisboa: Conselho Nacional de Saúde; 2019 [citado 2025 Fev 21]. Disponível em: https://www.cns.min-saude.pt/wp-content/uploads/2023/03/CNS-PNS-2020-2030-Termos-de-referencia.pdf
7. Pereira SR. A intervenção da equipa de enfermagem de reabilitação nos utentes submetidos a artroplastia total do joelho/anca [tese de mestrado na Internet]. Braga: Universidade do Minho; 2021 [citado 2025 fev 21]. Disponível em: https://repositorium.sdum.uminho.pt/bitstream/1822/76384/1/Sara%20Raquel%20Magalhaes%20Pereira.pdf
8. European Commission. Surgical operations and procedures statistics. 2023.https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Surgical_operations_and_procedures_statistics
9. Registo Português de Artroplastias. Hospitais/Estatísticas [Internet].2024 [citado 2025 fev 21]. Disponível em: http://www.rpa.spot.pt/Main-Sections/Hospitals.aspx
10. Alexandre BM. Intervenção do enfermeiro especialista em enfermagem de reabilitação: prehabilitation da pessoa proposta para cirurgia ortopédica [relatório de estágio na Internet]. Lisboa: Escola Superior de Enfermagem de Lisboa; 2020 [citado 2025 Fev 21]. Disponível em: https://comum.rcaap.pt/entities/publication/676cfd65-2ede-4bad-888d-f9a5ed8f3ca2 DOI:http://hdl.handle.net/10400.26/37307
11. Gonçalves CG, Groth AK. Pré-habilitação: como preparar nossos pacientes para cirurgias abdominais eletivas de maior porte?. Revista Colégio Brasileiro de Cirurgiões [Internet]. 25 novembro 2019 [citado 2025 fev 21]; 46 (5): 1-14. Disponível em: https://www.scielo.br/j/rcbc/a/Lb4YjJK79BfZPDksFrnb84c/?lang=pt DOI: https://doi.org/10.1590/0100-6991e-20192267
12. Coudeyre, E, Jardin, C, Givron, P, Ribinik, P, Revel, M, Rannou, F. Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines. Annales de readaptation et de medecine physique: revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique [Internet]. abril de 2017 [citado 2025 Fev 21]; 50(3): 189–197. Disponível em : https://www.sciencedirect.com/science/article/abs/pii/S0168605407000177?via%3Dihub DOI: https://doi.org/10.1016/j.annrmp.2007.02.002.
13. Meleis AI. (2012). Theoretical Nursing: Development and Progress. 5th ed. Pennsylvania: Wolters Kluwer/Lippincott Williams Wilkins; 2012.
14. Tricco AC, Langlois EV, Straus SE. Rapid reviews to strengthen health policy and systems: A practical guide. World Health Organization [Internet]. 10 agosto 2017 [citado 2025 fev 21]. Disponível em: https://wkc.who.int/resources/publications/i/item/2017-08-10-rapid-reviews-to-strengthen-health-policy-and-systems-a-practical-guide
15. Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping reviews. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis [Internet]. 2020 [citado 2025 fev 21]. Disponível em: https://synthesismanual.jbi.global
16. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine [Internet]. 4 setembro 2018 [citado 2025 fev 21]; 169(7): 467-473. Disponível em: https://www.acpjournals.org/doi/10.7326/M18-0850 DOI: https://doi.org/10.7326/M18-0850
17. Roach HA, Tremblay LM, Bowers DL. A preoperative assessment and education program-implementation and outcomes. Patient Education and Counseling [Internet]. fevereiro 1995 [citado 2025 fev 21]; 25(1): 83-88. Disponvível em: https://www.sciencedirect.com/science/article/abs/pii/0738399194006718 DOI:10.1016/0738-3991(94)00671-8
18. D’Lima DD Colwell CW, Morris BA, Hardwick ME, Kozin F. The Effect of Preoperative Exercise on Total Knee Replacement Outcomes. Clinical Orthopaedics and Related Research [Internet]. Maio 1996 [citado 2025 Fev 21]; 326: 174-182. Disponível em: https://journals.lww.com/clinorthop/abstract/1996/05000/the_effect_of_preoperative_exercise_on_total_knee.20.aspx DOI: doi: 10.1097/00003086-199605000-00020
19. Rodgers JA, Garvin KL, Walker CW, Morford D, Urban J, Bedard J. Preoperative Physical Therapy in Primary Total Knee Arthroplasty. The Journal of Arthroplasty [Internet]. junho 1998 [citado 2025 fev 21];13 (4): 414-421. Disponível em: https://pubmed.ncbi.nlm.nih.gov/9645522/ DOI: 10.1016/s0883-5403(98)90007-9
20. Beaupre LA, Lier D, Davies DM, Johnston DB. The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol. Junho 2004 [citado 2025 fev 21];31(6):1166–73.
21. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al. Effect of Preoperative Exercise on Measures of Functional Status in Men and Women Undergoing Total Hip and Knee Arthroplasty. Arthritis & Rheumatism [Internet]. 15 outubro 2006 [citado 2025 fev 21]; 55(5): 700–708. Disponível em: https://pubmed.ncbi.nlm.nih.gov/17013852/ DOI:10.1002/art.22223
22. Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM, Nyland JA. Prehabilitation before knee arthroplasty increases postsurgical function: a case study. J Strength Cond Res. Maio 2007 [citado 2025 fev 21];21(2):632–4.
23. Evgeniadis G, Beneka A, Malliou P, Mavromoustakos S, Godolias G. Effects of pre- or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation [Internet]. 1 agosto 2008 [citado 2025 fev 21]; 21 (3): 161–169. Disponível em: https://journals.sagepub.com/doi/abs/10.3233/BMR-2008-21303 DOI: https://doi.org/10.3233/BMR-2008-21303
24. McKay C, Prapavessis H, Doherty T. The Effect of a Prehabilitation Exercise Program on Quadriceps Strength for Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Pilot Study. American Academy of Physical Medicine and Rehabilitation [Internet]. 12 junho 2012 [citado 2025 fev 21]; 4(9): 647-656. Disponível em: https://onlinelibrary.wiley.com/doi/10.1016/j.pmrj.2012.04.012 DOI: http://dx.doi.org/10.1016/j.pmrj.2012.04.012
25. Lucas B, Cox C, Bridges J. Pre-operative preparation of patients for total knee replacement: An action research study. International Journal of Orthopaedic and Trauma Nursing [Internet]. Maio 2013 [citado 2025 fev 21]; 17(2): 79–90. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S1878124112000937?via%3Dihub DOI: https://doi.org/10.1016/j.ijotn.2012.08.005
26. Garson L, Schwarzkopf R, Vakharia S, Alexander B, Stead S, Cannesson M, et al. Implementation of a Total Joint Replacement-Focused Perioperative Surgical Home: A Management Case Report. Anesthesia & Analgesia [Internet]. Maio 2014 [citado 2025 fev 21]; 118(5): 1081-1089. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24781576/ DOI: 10.1213/ANE.0000000000000191
27. Van Leeuwen DM, de Ruiter CJ, Nolte PA, de Haan A. Preoperative strength training for elderly patients awaiting total knee arthroplasty. Rehabil Res Pract. Fevereiro 2014 [citado 2025 fev 21];2014:462750. Doi:10.1155/2014/462750
28. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen M, Andersen L. 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 [Internet]. setembro 2017 [citado 2025 fev 21];25:2864–2872. DOI:10.1007/s00167-016-3985-5
29. Soeters R, White PB, Murray-Weir M, et al. Preoperative Physical Therapy Education Reduces Time to Meet Functional Milestones After Total Joint Arthroplasty. Clin Orthop Relat Res. Janeiro 2018 [citado 2025 fev 21];476(1):40-48. Doi:10.1007/s11999.0000000000000010
30. Rittharomya J, Aree-ue S, Malathum P, Orathai P, Belza B, Kawinwonggowit V. The Effectiveness of Preoperative Quadriceps Exercise and Diet Control Program for Older Adults Waiting for Total Knee Arthroplasty: A Randomized Controlled Trial. Pacific Rim Int J Nurs Res [Internet]. Outubro-dezembro 2020 [citado 2025 fev 21]; 24(4): 485-501. Disponível em: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/228023
31. Gränicher P, Stöggl T, Fucentese S, Adelsberger R, Swanenburg S. Preoperative exercise in patients undergoing total knee arthroplasty: a pilot randomized controlled trial. Archives of Physiotherapy [Internet]. Janeiro-dezembro 2020 [citado 2025 fev 21]; 10(13): 1-11. Disponível em: https://www.archivesofphysiotherapy.com/index.php/aop/article/view/2877 DOI: https://doi.org/10.1186/s40945-020-00085-9
32. Durmus M, Bektas IO, Eren H. Effect of preoperative in-bed exercises and mobilization training on postoperative anxiety and mobilization level. Japan Journal of Nursing Science [Internet]. Maio 2020 [citado 2025 Fev 21]; 17(4): 1-8. DOI: https://doi.org/10.1111/jjns.12339
33. Zheng Y, Huang Z, Dai L, Liu Y, Chen Y, Zhang W, Lin R. The Effect of Preoperative Rehabilitation Training on the Early Recovery of Joint Function after Artificial Total Knee Arthroplasty and Its Effect Evaluation. Journal of Healthcare Engineering [Internet] Janeiro 2021 [citado 2025 Fev 21]; 1-6. DOI: https://doi.org/10.1155/2022/3860991
34. Li Z, Li B, Wang G, Wang K, Chen J, Liang Y, et al. Impact of enhanced recovery nursing combined with limb training on knee joint function and neurological function after total knee arthroplasty in patients with knee osteoarthritis. Am J Transl Res [Internet]. 15 junho 2021 [citado 2025 fev 21]; 13(6): 6864-6872. Disponível em: https://pubmed.ncbi.nlm.nih.gov/34306437/
35. Anderson, A, Comer, C, Smith, T, Drew, B, Pandit, H, Antcliff, et al. Consensus on pre-operative total knee Replacement education and prehabilitation recommendations: a UK-based modified Delphi study. BMC Musculoskeletal Disorders [Internet]. 14 Abril 2021 [citado 2025 Fev 21]; 22(352): 1-15. Disponível em https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04160-5 DOI: https://doi.org/10.1186/s12891-021-04160-5
36. Sunghye K, Hsu F, Groban L, Williamson J, Messier S. A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty – short term outcome. BMC Musculoskeletal Disorders [Internet]. 26 abril 2021 [citado 2025 fev 21]; 22(388): 1-11. Disponível em: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04253-1 DOI:https://doi.org/10.1186/s12891-021-04253-1
37. Franz A, Ji S, Bittersohl B, Zilkens C, Behringer M. Impact of a Six-Week Prehabilitation With Blood-Flow Restriction Training on Pre- and Postoperative Skeletal Muscle Mass and Strength in Patients Receiving Primary Total Knee Arthroplasty. Frontiers in Physiology [Internet]. 14 junho 2022 [citado 2025 fev 21] 13(881484): 1-15. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35774280/ DOI: 10.3389/fphys.2022.881484
38. Liu J, Zheng Q, Wu Y. Effect of enhanced recovery after surgery with multidisciplinary collaboration on nursing outcomes after total knee arthroplasty. World J Clin Cases. Novembro 2023 [citado 2025 fev 21];11(32):7745-7752. Doi:10.12998/wjcc.v11.i32.7745
39. Nguyen C, Boutron I, Roren A, Anract P, Beaudreuil J, Biau D, et al. Effect of Prehabilitation Before Total Knee Replacement for Knee Osteoarthritis on Functional Outcomes: A Randomized Clinical Trial. JAMA Network Open [Internet]. 1 março 2022 [citado 2025 fev 21]; 5(3):1-15. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35262716/ DOI:10.1001/jamanetworkopen.2022.1462
40. Gstoettner M, Raschner C, Dirnberger E, Leimser H, Krismer M. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee. Agosto 2011 [citado 2025 fev 21];18(4):265-270. Doi:10.1016/j.knee.2010.05.012
41. Matassi F, Duerinckx J, Vandenneucker H, Bellemans J. Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program. Knee Surgery, Sports Traumatology, Arthroscopy [Internet]. março 2013 [citado 2025 fev 21]; 22: 703–709. Disponível em: https://pubmed.ncbi.nlm.nih.gov/23271039/ DOI:10.1007/s00167-012-2349-z
42. Jahic D, Omerovic D, Tanovic A, Dzankovic F, Campara M. (2018). The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty. MED ARCH [Internet]. Dezembro 2018 [citado 2025 fev 21]; 72(6: 439-443. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30814777/ DOI: 10.5455/medarh.2018.72.439-443
43. Brendon HR, Holly BC, James DC , Ulla R, David G, Kate NT. Maintenance of Preoperative Fitness by Home-Based Prehabilitation Following Supervised Prehabilitation in Patients Awaiting Total Hip or Knee Arthroplasty. International Journal of Research in Exercise Physiology. Maio 2024 [citado 2025 fev 21];19 (2):57-77. Disponível em : https://hdl.handle.net/10523/23796
44. Mitchell C, Walker J, Walters S, Morgan AB, Binns T, Mathers N. Costs and effectiveness of pre- and post-operative home physiotherapy for total knee replacement: randomized controlled trial. Journal of Evaluation in Clinical Practice [Internet]. Junho 2005 [citado 2025 fev 21]; 11(3): 283–292. Disponível em: https://pubmed.ncbi.nlm.nih.gov/15869558/ DOI:10.1111/j.1365-2753.2005.00535.x
45. Huang SW, Chen PH, Chou YH. Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patients. Orthop Traumatol Surg Res. Maio 2012 [citado 2025 fev 21];98(3):259-264. doi:10.1016/j.otsr.2011.12.004
46. Aytekina,E ,Sukurb, E, Oza,N, Telatarb, A, Demirc, S, Caglara, N, et al. The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study. Journal of Clinical Orthopaedics and Trauma [Internet]. Março-abril [citado 2025 Fev 21];10 (2): 345-349. Disponível em: https://www.journal-cot.com/article/S0976-5662(18)30091-2/abstract DOI: https://doi.org/10.1016/j.jcot.2018.04.006.
47. Wang L, et al. Effect of preoperative exercise therapy on outcomes of total knee arthroplasty: A meta-analysis. Clinical Rehabilitation [Internet]. Outubro 2021 [citado 2026 fev 21]; 35(10): 1399–1412. DOI: https://doi.org/10.1177/02692155211002418
48. Konnyu KJ, Thoma LM, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Pinto D, Balk EM. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. American journal of physical medicine & rehabilitation [Internet]. Janeiro 2023 [citado 2026 fev 21]; 102(1):1–10. DOI: 10.1097/PHM.0000000000002006
49. Adebero T, Omana H, Somerville L, Lanting B, Hunter SW . Prehabilitation before total knee arthroplasty: Effects on postoperative outcomes and quality of evidence. Knee Surgery & Related Research [Internet]. fevereiro 2024 [citado 2026 fev 21]; 36(1): 1–13. DOI: https://doi.org/10.1080/09638288.2024.2313128
50. Punnoose A, et al. The effectiveness of prehabilitation for patients undergoing total knee arthroplasty: A systematic review and meta-analysis. BMC Musculoskeletal Disorders [Internet]. Abril 2023 [citado 2026 fev 21]; 24: 317. DOI: https://doi.org/10.1186/s12891-023-06352-3
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