Rehabilitation with or without acupuncture for improving the knee function after total knee arthroplasty: A systematic review and meta-analysis

Objective

To assess the effect and safety of acupuncture on the base of rehabilitation for knee function after total knee arthroplasty.

Methods

Relevant articles were collected from CNKI, Sinomed, Wanfang, VIP, Cochrane Library, Medline and Embase. The search was conducted by using a combination of subject terms and free words. The data were analyzed by Revman 5.4 software, and the included studies were evaluated in compliance with the Cochrane Collaboration's tool for assessing risk of bias in randomized trials.

Results

A total of 10 studies of randomized controlled trial (RCT) were included, with 785 participants involved, of which, 393 cases in experiment group and 392 cases in control group. The interventions were electroacupuncture in 4 RCTs, filiform needling in 4 RCTs and transcutaneous electrical acupoint stimulation in 2 RCTs. Meta-analysis results showed that, compared with rehabilitation alone, acupuncture combined with rehabilitation improved the score of Hospital for Special Surgery (HSS) (MD=4.27, 95% CI=[2.77, 5.78], Z=5.58, P<0.00001), increased the range of motion (ROM) of the knee (MD=3.09, 95% CI=[1.47,4.70], Z=3.75, P<0.001), and decreased the postoperative score of visual analogue scale (VAS) (MD=-0.53, 95%CI=[-0.74, -0.33], Z=5.04, P<0.00001), but the difference in VAS score between groups only indicated statistical significance, without clinical importance. The sensitivity analysis showed the results were stable. In subgroup analysis, the stability of VAS score was relatively poorer in electroacupuncture group and filiform needle group, which may be associated with the differences in waveform of electroacupuncture and trial setting.

Conclusion

Compared with rehabilitation alone, acupuncture in combination with rehabilitation could effectively improve the knee function for the patients after total knee arthroplasty.