Significance of a 4-week home-based prehabilitation program in accelerating 3-month recovery post total knee arthroplasty: a retrospective cohort study

BACKGROUND: Preoperative rehabilitation is one of the strategies for enhanced recovery after surgery (ERAS) following total knee arthroplasty (TKA), but the optimal duration remains inconclusive. This study aims to evaluate the impact of a 4-week home-based prehabilitation program on accelerating postoperative recovery in patients undergoing TKA. METHODS: In this retrospective cohort analysis, 176 patients undergoing primary unilateral TKA were categorized into two groups: those who completed a 4-week home-based prehabilitation program (training group, n = 72) and those who did not (control group, n = 104). Baseline demographics, perioperative data, pain scores, and functional outcomes were collected. Patients were followed for over 1 year. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and secondary outcomes included visual analog scale (VAS), knee range of motion (ROM), Knee Society Score (KSS), timed up-and-go (TUG) test, and stair climbing test. Assessments were performed at baseline, before surgery, and multiple time points after TKA. RESULTS: Baseline characteristics were comparable between groups. The training group demonstrated significantly earlier first postoperative ambulation (median 9 versus 12 h, P = 0.003) and shorter hospital stays (median 7 versus 10 days, P = 0.002). Pain scores (VAS) were significantly lower in the training group at 1 day and 1 week postoperatively (P < 0.05). Functional outcomes including ROM, KSS, TUG, and stair test were superior in the training group at 1 and 3 months (P < 0.05). WOMAC total scores and its subscales (pain, stiffness, function) also showed significant improvements in the Training group at 1 and 3 months (P < 0.05). While advantages in ROM and TUG persisted up to 6 months, no significant between-group differences were observed at 12 months for any outcome measure. CONCLUSIONS: A 4-week home-based prehabilitation program significantly enhances early recovery after TKA, as evidenced by reduced hospital stay, lower early postoperative pain, and improved functional outcomes within the first 3 months. Although benefits in certain functional measures persist up to 6 months, outcomes converge by 12 months. These findings support the integration of structured 4-week home-based prehabilitation program into ERAS pathways.