A systematic review of pre-operative and intra-operative acupuncture in total hip and knee arthroplasty

Objective: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common elective surgical procedures that are often associated with significant post-operative pain, commonly leading to opioid use. Acupuncture has been studied as a non-invasive approach to alleviate post-operative pain and reduce opioid consumption. Our aim was to review the literature to assess the efficacy of pre-operative and intra-operative acupuncture as an analgesic adjunct for arthroplasty patients. Methods: This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. A comprehensive search was conducted in multiple databases to identify studies that utilized acupuncture in primary THA and TKA patients from their inception to June 2023. Inclusion criteria included full-text availability and publication in the English language. Results: Eight studies were included in the final analysis, comprising seven randomized controlled trials and one prospective cohort study. Meta-analysis was not feasible due to the heterogeneity of study design and outcome measures. Acupuncture use led to a significant reduction in total intra-operative fentanyl and post-operative patient-controlled analgesia (PCA) use in THA and TKA patients. Patients who received acupuncture reported fewer analgesic-related side effects. However, patient-reported outcome measures (PROMs) varied among studies, with no consistent trend observed. Conclusion: The incorporation of pre- and intra-operative acupuncture into arthroplasty protocols may help reduce opioid usage and minimize analgesia-related side effects. It appears, based on the available literature, that acupuncture has the potential to improve pain management in arthroplasty patients. Although the number of studies remains limited, the cost-effectiveness and ease of implementation of acupuncture suggest that it could be an advantageous adjunct in the peri-operative setting. Further research is needed to establish best practices and guide healthcare professionals on the use of acupuncture in arthroplasty patients.