No Added Benefit for Acupuncture in Routine Rehabilitation After Total Knee Replacement

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Addition of acupuncture to routine best care rehabilitation after total knee replacement may not provide further benefits.
Addition of acupuncture to routine best care rehabilitation after total knee replacement may not provide further benefits.

The addition of adjunctive acupuncture to routine rehabilitation therapy after total knee replacement (TKR) surgery may not provide a significant benefit over exercise only to relieve postoperative pain, according to a randomized study published in Pain Medicine.

Patients undergoing TKR who were referred for postoperative outpatient physical rehabilitation and received no supplementary therapy during their intervention were enrolled in this small, randomized study. Three weeks after TKR, 172 patients were randomly assigned to an exercise and acupuncture group (n=87) or an exercise-only group (n=85).

Exercise consisted of aerobic, functional, stabilizing, strengthening, and mobilizing exercises. The study's primary outcome was the percentage of patients reporting a reduction of evening/night knee pain (score ≤4 on a 0 to 10 numeric rating scale) after 14 acupuncture treatments.

A ≥16.7-point change in score on the Knee injury and Osteoarthritis and Outcomes Score (KOOS) after treatment and 3 months posttreatment was one of the secondary outcomes, which also included improvements in activity of daily living and quality of life.

The acupuncture/exercise group and exercise-only group reported similar levels of evening pain (79% vs 84%, respectively; relative risk [RR], 0.94; 95% CI, 0.81-1.0) and night pain (84% vs 86%, respectively; RR, 0.98; 95% CI, 0.86-1.11). Compared with participants in the exercise-only group, patients also receiving acupuncture experienced no significant benefit with regard to pain or disability changes at follow-up. Patients with a previous positive acupuncture experience did not experience a higher benefit compared with those with no or negative prior experience.

Participants who had been treated with acupuncture in addition to exercise vs exercise alone had similar mean changes posttreatment and at 3-month follow-up in KOOS pain (P =.624 and P =.680, respectively), KOOS symptoms (P =.511 and P =.698, respectively), and KOOS activities of daily living (P =.636 and P =.936, respectively).

The investigators note that 2 possibly effective acupuncture points near the operated knee were not used during therapy in an effort to maintain safety. In addition, they did not collect data on changes in patients' medication and/or therapy use during the 3-month follow-up, which could have had an impact on outcomes.

The investigators concluded, ”Our results do not support the addition of acupuncture to routine best care rehabilitation,” adding, “We did not find that previous benefit from acupuncture was able to identify those likely to respond to acupuncture.”

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Reference

Petersen T, Hautopp H, Duus B, Juhl C. No effect of acupuncture as adjunctive therapy for patients with total knee replacement: a randomized controlled trial [published online December 27, 2017]. Pain Med. doi: 10.1093/pm/pnx317.

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