Acupuncture is safe and effective for pain management of patients following total knee replacement surgery, according to the authors of a systematic literature review published in Pain Medicine.

Although systematic reviews of acupuncture treatment for knee osteoarthritis have been conducted previously, data are lacking on the effectiveness of acupuncture for alleviation of pain post total knee replacement. Researchers therefore conducted a systematic literature review of randomized controlled trials in 5 English and 5 Chinese medical electronic databases, to evaluate whether patients who undergo total knee replacement benefit from acupuncture following surgery.

Of 598 studies identified, 7 studies with 470 participants were included in the final meta-analysis. These randomized controlled trials included 470 participants (treatment groups, n=237; control groups, n=233). Average patient age ranged between 28 and 81 years. Five studies were conducted in Eastern countries and 2 studies were conducted in Western countries.


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Four studies explained only their research randomization methods and did not include details on the random allocation or group division methods, and 1 study did not provide a description of its randomization methods. Five studies did not indicate the concealment methods used to maintain privacy following randomization. All 7 studies selected “presented their research results clearly,” according to the researchers.

The investigators conducted a meta-analysis of the 7 studies to evaluate the analgesic effects of acupuncture following total knee replacement. Calculations showed an “absence of sample homogeneity” across all 7 studies. A forest map demonstrated that the overall effect size was −0.705 (95% CI, −1.027 to −0.382).

The 7 studies used either the Visual Analogue Scale (VAS) or the Chinese version of the 11-point numerical pain scale. Because only 1 study used the latter scale, the meta-analysis was only performed for the VAS. An initial analysis indicated medium heterogeneity, and a forest map indicated an overall effect size of −0.700 (95% CI, −1.061 to −0.340).

Three studies included data on the use of analgesic drugs. A forest map showed that the overall effect size was −0.567 (95% CI, −0.865 to −0.269).

Evaluations indicated an absence of publication bias.

Study limitations include a lack of generalizability; potential bias within the studies; and a lack of data on names, doses, and prescriptions of analgesic drugs.

“[A]cupuncture intervention alleviated pain in post-[total knee replacement] patients,” the researchers wrote. “Statistically significant differences were found in VAS results. No serious adverse events were found during acupuncture.”

“In brief, acupuncture therapy is an effective and safe treatment for [post-total knee replacement patients], and it can be recommended for the management of [these] patients,” the researchers concluded. “However, more large-scale [randomized controlled trials] are needed to investigate the therapeutic effect of acupuncture for [these] patients in the long-term.”

Reference

Ko HF, Chen C-H, Dong K-R, Wu H-C. Effects of acupuncture on postoperative pain after total knee replacement: systematic literature review and meta-analysis. Pain Med. Published online June 21, 2021. doi:10.1093/pm/pnab201