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OBJECTIVES: Although total knee replacement (TKR) is cost effective and successful in most cases, patient-reported outcome measures demonstrate 20% of people remain unsatisfied at 1 year after a technically successful procedure. Our group has previously shown that patients with severe knee osteoarthritis (OA) awaiting surgery can achieve a short-term reduction in symptom severity when treated with acupuncture, and that a trend towards improved walking distance, as a measure of function, is achieved with preoperative supervised exercise. The aim of this study was to evaluate the effect of combined acupuncture and physiotherapy on preoperative and postoperative pain and function. METHODS: A total of 56 patients awaiting TKR surgery were randomised to receive either combined physiotherapy and acupuncture or a standardised exercise and advice leaflet. Pain and function were measured primarily using the Oxford Knee Score (OKS), with assessments at baseline prior to intervention, 6 and 12 weeks after intervention and at 3 months postoperatively. RESULTS: Due to the introduction of the 18-week waiting times target during this study, the required sample size was not achieved. There were no significant differences demonstrated between the control and treatment groups for OKS. Seven patients withdrew from surgery because of symptomatic improvement in their knees: six from the treatment group and one from the control group (OR 7.64, 95% CI 0.86 to 68.20). CONCLUSIONS: This study demonstrated that the use of combined acupuncture and physiotherapy in the treatment of patients with moderate to severe knee OA preoperatively did not improve patient outcome postoperatively. As the study was underpowered, a larger trial is required to examine this result further.

Original publication

DOI

10.1136/acupmed-2012-010128

Type

Journal article

Journal

Acupuncture in medicine : journal of the British Medical Acupuncture Society

Publication Date

09/2012

Volume

30

Pages

176 - 181

Addresses

Department of Rheumatology, The Great Western Hospital, Swindon, Wiltshire, UK.

Keywords

Humans, Osteoarthritis, Knee, Treatment Outcome, Combined Modality Therapy, Acupuncture Therapy, Exercise Therapy, Postoperative Care, Preoperative Care, Arthroplasty, Replacement, Knee, Aged, Aged, 80 and over, Middle Aged, Female, Male