Table 2. Main Findings of the Meta-analysis of Nonpharmacological Postoperative Pain Management After Total Knee Arthroplastya.
| Variable | No. of Studies | No. of Participants | Effect Estimate (95% CI) | I2 Heterogeneity, % | GRADE |
|---|---|---|---|---|---|
| Pain Relief on the VAS | |||||
| CPM | 9 | 1025 | −0.05 (−0.35 to 0.25) | 52 | Very low |
| 1 wk | 8 | 575 | −0.27 (−0.70 to 0.16) | 35 | |
| 2 wk | 2 | 145 | −0.81 (−3.30 to 1.68) | 88 | |
| 3 mo | 2 | 170 | 0.50 (−0.30 to 1.29) | 54 | |
| 6 mo | 2 | 135 | 0.15 (−0.04 to 0.35) | 0 | |
| Cryotherapy | 8 | 1382 | −0.51 (−1.00 to −0.02) | 62 | Very low |
| Day 1 after surgery | 7 | 529 | −0.21 (−0.89 to 0.48) | 40 | |
| Day 2 after surgery | 5 | 422 | −1.00 (−2.01 to 0.02) | 59 | |
| Day 3 after surgery | 6 | 431 | −0.44 (−1.37 to 0.49) | 75 | |
| Electrotherapy | 2 | 189 | −2.11 (−2.74 to −1.47) | 80 | Very low |
| 1 mo | 2 | 63 | −1.95 (−2.68 to −1.22) | 17 | |
| 2 mo | 2 | 63 | −2.34 (−4.49 to −0.19) | 94 | |
| 6 mo | 2 | 63 | −2.60 (−5.12 to −0.08) | 83 | |
| Acupuncture | 3 | 230 | −0.66 (−1.29 to −0.03) | 69 | Low |
| 2 d | 2 | 90 | −1.14 (−1.90 to −0.38) | 0 | |
| 8 d | 2 | 140 | −0.37 (−1.04 to 0.30) | 72 | |
| Pain Relief on the WOMAC | |||||
| CPM | 5 | 578 | 0.03 (−0.19 to 0.24) | 0 | Low |
| 6 wk | 2 | 168 | −0.66 (−2.12 to 0.81) | 60 | |
| 3 mo | 3 | 242 | 0.05 (−0.22 to 0.32) | 0 | |
| 6 mo | 2 | 168 | −0.34 (−1.35 to 0.68) | 0 | |
| Preoperative exercise | 3 | 132 | −0.14 (−1.11 to 0.84) | 65 | Low |
| 6 wk | 2 | 60 | 0.34 (−0.32 to 0.99) | 0 | |
| 12 wk | 2 | 72 | −0.78 (−1.63 to 0.07) | 8 | |
| Opioid Consumptionb | |||||
| CPM | 5 | 313 | 6.58 (−6.33 to 19.49) | 87 | Very low |
| 1 wk | 3 | 178 | 11.12 (−12.21 to 34.44) | 80 | |
| 2 wk | 2 | 135 | −3.78 (−7.67 to 0.11) | 8 | |
| Cryotherapy within 48 h | 7 | 468 | −0.13 (−0.26 to −0.01) | 86 | Very low |
| Cryotherapy vs nothing | 2 | 61 | −0.18 (−0.30 to −0.06) | 0 | |
| Cryotherapy vs compression | 5 | 407 | −0.12 (−0.28 to 0.04) | 90 | |
| Electrotherapy within 48 h | 2 | 99 | −3.50 (−5.90 to −1.10) | 17 | Moderate |
| Acupuncture within 48 h | 2 | 123 | −0.71 (−1.44 to 0.02) | 64 | Low |
| Acupuncture vs sham acupuncture | 2 | 90 | −0.92 (−2.19 to 0.35) | 79 | |
| Acupuncture vs nothing | 1 | 33 | −0.40 (−1.05 to 0.25) | NA | |
| NSAID Consumption | |||||
| Cryotherapy within 48 h | 3 | 363 | −0.75 (−1.63 to 0.12) | 95 | Very low |
| Cryotherapy vs nothing | 1 | 60 | −1.90 (−2.25 to −1.55) | NA | |
| Cryotherapy vs compression | 2 | 303 | −0.31 (−0.55 to −0.07) | 0 | |
| Time to First PCAc | |||||
| Acupuncture | 2 | 124 | 46.17 (20.84 to 71.50) | 19 | Moderate |
| Acupuncture vs sham acupuncture | 2 | 91 | 34.58 (−12.61 to 81.77) | 53 | |
| Acupuncture vs nothing | 1 | 33 | 57.90 (16.52 to 99.28) | NA | |
Abbreviations: CPM, continuous passive motion; GRADE, Grades of Recommendation, Assessment, Development, and Evaluation; NA, not available; NSAID, nonsteroidal anti-inflammatory drug; PCA, patient-controlled analgesia; VAS, visual analog scale (range, 0-10); WOMAC, Western Ontario and McMaster Universities Arthritis Index Scale (range, 0-20).
a
The inverse variance method was used for the statistical analyses.
b
Units are the mean use of morphine equivalents in milligrams at 1 and 2 weeks for CPM, the number of tablets per 48 hours for cryotherapy, and morphine equivalents in milligrams per kilogram per 48 hours for all other variables under this heading.
c
Units are minutes after surgery.