Efficacy of Acupuncture during the Post-Acute Phase of Rehabilitation After Total Knee Arthroplasty

This is a review of a clinical observation study conducted in Japan evaluating the efficacy of acupuncture in respect to pain relief, reduction of swelling around the knee, and early recovery of ROM after total knee arthroplasty (TKA).

by Hitomi Asano L.Ac

Post-operative management is an integral component for the recovery of the patient after total knee arthroplasty.

This clinical observation followed patients after unilateral cemented TKA surgery from January 2009 to December 2011 at the Takagi hospital in Japan. 80 patients were randomly assigned to either an acupuncture treatment group (Group A) or a control group (Group C). Group C (n=40) received a standard postoperative treatment during the initial period of rehabilitation after TKA. Group A (n=40) received complimentary acupuncture as an adjunct to the standard postoperative treatment.

Group A received acupuncture 3x/week from the postoperative day (POD) 7 until POD 21, a total of 6 treatments in the span of 2 weeks. The acupuncture needles used were 40G (0.16 mm) Seirin needles. The depth of the needle insertion varied but usually 1-1.5 cm. The acupuncture needles were left in for 20-30 minutes with ‘de qi’ stimulation. The acupuncture points used were ST (31, 32, 38), SP (6), BL (23, 25, 37, 57, 60), KI (3), GB (31, 39, 40, 41, 42) and LR (3).

Outcome measures were 1) improvement in pain using ratios of visual analog scale (VAS) on PODs 14 and 21 to that on POD 6; 2) improvement in swelling around the knee according to ratios of knee circumference on PODs 14 and 21 to that on POD 6; 3) time to achieve a preoperative range of motion (ROM).

The mean VAS pain score on POD 6 was 60 mm in Group A and 59 mm in Group C. By POD 14, Group A had lowered to 25 mm and Group C to 35 mm. By POD 21, Group A had lowered to 16 mm and Group C to 24 mm. The ratios of improvement in pain intensity were better in the acupuncture group and statistically significant at POD 14 and POD 21.

The improvement in the ratio of reduction of swelling around the knee on POD 14 for Group A was 0.49 and Group C was 0.61. By POD 21, it improved to 0.30 in Group A and 0.39 in Group C. The difference was statistically significant at PODs 14 and 21.

The mean ROM before surgery was 118.5˚ in Group A and 120.8˚ in Group C. This difference was not significant. The mean time to achieve preoperative ROM for Group A was 15.2 days and Group C was 20.9 days. The difference was statistically significant.

Incorporating acupuncture into postoperative care after TKA helps reduce pain, improve swelling, and reach preoperative ROM faster than just the standard postoperative care.

Mikashima, Yoshinori, et al. “Efficacy of Acupuncture during Post-Acute Phase of Rehabilitation after Total Knee Arthroplasty.” Journal of Traditional Chinese Medicine, vol. 32, no. 4, 2012, pp. 545–548., doi:10.1016/s0254-6272(13)60068-0.

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