Current evidence on multimodal prehabilitation before total joint arthroplasty: A narrative review

Objective: To critically synthesize current evidence on unimodal and multimodal prehabilitation before total hip arthroplasty (THA) and total knee arthroplasty (TKA). 
Methods: This narrative review included 34 publications comprising systematic reviews, randomized controlled trials, observational studies, clinical guidance documents, and conceptual papers. The evidence was organized according to intervention component, type of arthroplasty, patient risk profile, delivery model, and clinical outcomes, while methodological limitations were assessed qualitatively.
Results: Exercise showed the clearest potential to improve preoperative physical function, strength, walking capacity, and cardiorespiratory fitness, but postoperative benefits were inconsistent. Nutritional interventions improved protein intake or attenuated perioperative muscle loss without consistent functional improvement. Psychological strategies may reduce anxiety, catastrophizing, and early pain in selected patients, whereas education mainly improved knowledge and preparedness. Evidence for pain, postoperative function, length of stay, quality of life, and healthcare utilization was mixed; evidence for complications, readmission, and cost-effectiveness was insufficient. TKA predominated in the literature, and THA-specific postoperative evidence remained limited. 
Conclusion: Current evidence does not support mandatory intensive multimodal prehabilitation for every arthroplasty candidate. A risk-stratified approach integrated with enhanced recovery pathways is more defensible, with components selected according to documented physical, nutritional, psychological, and accessibility needs.