SEVERE OSTEOARTHRITIS OF THE KNEE: A RANDOMISED CONTROLLED TRIAL COMPARING STANDARDISED WESTERN ACUPUNCTURE, SUPERVISED EXERCISE THERAPY AND STANDARD MANAGEMENT FOR PATIENTS AWAITING KNEE ARTHROPLASTY.

Abstract

Background. Patients with severe osteoarthritis of the knee often have to endure many months of pain and limited function whilst waiting for surgery. Measures that can improve quality of life and knee function while on waiting lists are worth employing and may improve post-operative recovery. This study was designed to evaluate the effects of standardised western acupuncture and supervised exercise therapy on pain control and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty.

Methods. A three arm, single blind, randomised controlled trial was devised and took place at the Great Western Hospital, Swindon, UK. 181 patients awaiting knee arthroplasty met eligibility criteria and were entered into the trial. Block computerized randomisation was used to allocate patients to one of three treatment groups using a blinded third party. The three treatment groups were acupuncture for six weeks; supervised exercise therapy for six weeks or standardised advice. Outcome measures were assessed at 7 and 12 weeks following the initiation of treatment. The main outcome measures used were the Oxford Knee Score questionnaire, a 50 meter timed walk and duration of hospital stay following knee arthroplasty. Statistical analysis was performed with one way variance (ANOVA) analysis by intention to treat. Bonferroni method was used for analysis of statistically significant group differences.

Results. There was no baseline difference between groups. At 7 weeks there was a 10% reduction in Oxford Knee Score in the acupuncture group and a significant difference between the acupuncture and the other two groups: mean (SD) acupuncture 36.8 (7.2); physiotherapy 39.2 (8.2); control 40.3 (8.48) (p=0.0497). The supervised exercise group had a lower mean 50 meter walking time (50.3 seconds SD 17.7) compared to the acupuncture group (54.9 seconds SD 17) and the control group (58.4 seconds SD 25.2). Both these effects were still present but diminished at twelve weeks. There was a trend (p=0.0984) towards a shorter inpatient stay of one day for the physiotherapy group (mean 6.5 days SD 2.0) compared to the acupuncture group (mean 7.77 days SD 3.96).

Conclusions. Acupuncture can provide short-lived pain relief and improvement in function in patients with severe knee osteoarthritis awaiting knee arthroplasty. Supervised exercises lead to improvement in mobility. This functional improvement may decrease duration of hospital stay. Both interventions can be delivered safely and effectively in an outpatient group setting in a district general hospital and appear to be worthwhile for patients on the waiting list for surgery. Further evaluation of the effects of both treatments delivered simultaneously is planned.