Does acupuncture improve symptoms in patients with osteoarthritis who are awaiting knee replacement surgery?

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Abstract

BACKGROUND

Preoperative therapy for pain and function can improve postoperative outcomes for patients with knee osteoarthritis (OA).

OBJECTIVE

To compare the effects of acupuncture and physiotherapy on function and pain in patients with severe osteoarthritic knee pain awaiting knee replacement surgery.

DESIGN AND INTERVENTION

This UK-based, blind-assessment, three-arm, randomized controlled trial took place between September 2004 and March 2006. Patients on the waiting list for knee surgery, Including patients with OA, patients with unilateral or bilateral knee pain, and patients experiencing pain for more than 3 months, were invited to take part in the study. Patients were excluded if they had rheumatoid arthritis, ipsilateral OA of the hip, back pain associated with referred leg pain, psoriasis or other skin disease in the region of the knee; patients were also excluded if they were taking anticoagulants, had received an intra-articular steroid injection <2 months before enrolment or if they had undergone acupuncture or physiotherapy treatment during the previous year. Nonstratified, computerized block randomization was used to allocate patients into acupuncture, physiotherapy and standard management groups. The physiotherapy and acupuncture groups attended their respective treatment sessions once a week for 6 weeks. The control group was standardized by following advice from a home exercise leaflet. Patients were assessed at baseline, week 7,week 12 and 3 months after knee arthroplasty.

OUTCOME MEASURES

The main outcome measures were the Oxford Knee Score (OKS) questionnaire, 50 m timed walk and postoperative length of hospital stay.

RESULTS

A total of 181 patients awaiting knee arthroplasty were included in the study; 61 were allocated to the standard management (control) group, and 60 patients apiece were assigned to the physiotherapy and acupuncture groups. BMI, sex ratio and age were similar at baseline for all three groups. Assessments at week 7 and week 12 were performed in 161 (89%) and 120 (66%)patients respectively. Participant dropout during this period was attributed to social or medical reasons preventing patient attendance (n = 20) or patients being unhappy with their treatment allocation (n = 23). Assessments at 3 months postoperatively were performed in 69 (38%) of patients. Surgery withdrawal or delay, patient nonattendance owing to other hospital appointments, and inability to contact some patients accounted for the large number of dropouts at this stage. At week 7, mean OKS was lower in patients receiving acupuncture than in patients receiving physiotherapy (36.8 ± 7.20 versus 39.2 ± 8.22), and significantly lower than the control group (36.8 ± 7.20 versus 40.3 ± 8.48, P=0.0497). At 12 weeks the differences in OKS were no longer significant (P=0.156). Mean postoperative hospital stay was 1 day shorter for the physiotherapy group compared with the acupuncture group (6.5 days versus 7.77 days), although this was not statistically significant.

CONCLUSION

Short-term reduction in OKS for patients with knee OA awaiting joint replacement surgery can be achieved with acupuncture therapy.

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