22. February 2018 · Comments Off · Categories: Acupuncture, Knee Osteoarthritis, Surgery

A systematic review by American authors has concluded that acupuncture and electrotherapy can reduce opioid consumption after total knee arthroplasty. Thirty-nine randomised trials (2391 patients), which examined the use of various drug-free interventions (passive motion, preoperative exercise, cryotherapy, electrotherapy and acupuncture), were included in their meta-analysis. Moderate-certainty evidence showed that electrotherapy reduced the use of opioids and that acupuncture delayed opioid use. There was also low-certainty evidence that acupuncture improved pain, based on visual analogue scores. None of the other therapies studied showed any significant effects on either pain or opioid use.

Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. 2017 Aug 16:e172872.

UK researchers examining economic data on 12 non-pharmacological interventions for osteoarthritis of the knee (KOA) have found acupuncture and transcutaneous electrical nerve stimulation (TENS) to be cost-effective. The authors applied network meta-analysis to data from 88 randomised controlled trials including 7,507 patients. They based their cost-effectiveness estimations on a threshold of £20–30,000 per QALY (quality-adjusted life year – a measure of disease burden used to assess the value for money of medical interventions), as this is used by the UK’s National Institute for Health and Care Excellence (NICE) to assess whether treatments represent a cost-effective use of UK NHS resources. When all trials were considered, TENS was found to be cost-effective at the NICE threshold, with an incremental cost-effectiveness ratio of £2,690 per QALY versus usual care (meaning one quality-adjusted life year would be gained for each additional £2,690 spent on TENS). When only higher quality trials were considered, acupuncture was found to be cost-effective (with an incremental cost-effectiveness ratio of £13,502 per QALY versus TENS). The authors further noted that, while acupuncture is not currently recommended by NICE as a treatment for KOA, based on their calculations some interventions that are recommended by NICE (insoles, braces and manual therapy) are unlikely to be cost-effective and therefore should not be prioritised for commissioning within the NHS.
Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One. 2017 Mar 7;12(3):e0172749.