Total knee arthroplasty is a frequently performed procedure that causes moderate to severe postoperative pain in most patients, some of whom have pain for a longer period than anticipated. Because inadequately managed pain causes a host of short- and long-term effects, and because opioid addiction is a growing national concern, researchers sought to determine the effectiveness of nonpharmacologic interventions as alternatives to opioid treatment after total knee arthroplasty.

In this systematic review and meta-analysis, researchers evaluated the effectiveness of interventions that have been commonly studied, including continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. The evidence was gathered from 39 randomized controlled trials, which included a total of 2,391 patients.

Electrotherapy was found to reduce pain severity both following surgery and for up to six months. Acupuncture, however, was most beneficial in reducing pain in the early stages of recovery and less effective long term. Both electrotherapy and acupuncture were also found to reduce opioid consumption. There was very low-certainty evidence that cryotherapy reduced opioid consumption and no evidence that it improved pain. Neither continuous passive motion nor preoperative exercise helped to alleviate postoperative pain or to reduce consumption of opioids.

The researchers note that additional research with "high-quality" randomized controlled trials is needed to support these findings.-KC

REFERENCE