Four studies (three RCTs(2,4,5) and one non-RCT(3)) examined the effectiveness of acupuncture for patients awaiting total knee replacement(2,3,5) or total hip replacement surgery(4). This was compared to a control group receiving no treatment(2-3) in two studies, or an advice leaflet on exercise in one study(4). The final study was a three arm RCT and compared the intervention to a group receiving a six week physiotherapy programme or a group receiving an advice leaflet(5).
In three of the studies, participants in the intervention group received acupuncture once per week for three weeks (3-5), whereas in one study, participants received acupuncture twice per week for three weeks (2).
Knee Function:
Might be effective (three studies, one moderate (2) and two weak quality (3,5); showing a significant effect for the intervention compared to control. Evidence graded as inconsistent overall due to two of the included studies being of weak quality).
Walking Ability:
Might be effective (one moderate (2) and one weak quality study (3), showing a significant effect for the intervention group compared to control. One weak quality (5) study showing no effect for the intervention compared to control. Evidence graded as inconsistent overall due to two of the included studies being of weak quality).
Climbing Ability:
Might be effective (one moderate (2) and one weak quality study (3), showing a significant effect for the intervention group, compared to control. Evidence graded as inconsistent overall due to one of the included studies being of weak quality).
Health Status:
Evidence is inconsistent (one moderate (4) and one weak quality study (5); inconsistent results between studies).
Pain:
Evidence is inconsistent (two weak quality studies (3,5); inconsistent results between studies).
Delay/Cancellation of surgery:
In two weak quality studies (3,5) six patients in the intervention groups reported improvements to the extent that they requested to be suspended or withdrew from the surgery waitlist.)
Drug Use:
In one moderate study (4) five patients in the intervention group and three in the control group reduced their analgesia intake immediately post intervention (statistical significance not reported).
Cost-effectiveness:
In one weak quality study (5), the cost for acupuncture intervention was £15 per person, for the physiotherapy group was £9 per person and there was no additional cost for the advice and self-directed exercise leaflet group.