Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement

Objective. To evaluate the effects of standardized western acupuncture and physiotherapy on pain and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty. Methods. Three-arm, assessor-blind, randomized controlled trial. Participants: 181 patients awaiting knee arthroplasty. Interventions: acupuncture for 6 weeks; physiotherapy for 6 weeks; standardized advice. Main outcome measures: Oxford Knee Score questionnaire (OKS) (primary); 50 m timed walk, and duration of hospital stay following knee arthroplasty. Results. There was no baseline difference between groups. At 7 weeks, there was a 10% reduction in OKS in the acupuncture group which was a significant difference between the acupuncture and the control group: Mean (S.D.) acupuncture 36.8 (7.20); physiotherapy 39.2 (8.22); control 40.3 (8.48) (P=0.0497). These effects were no longer present at 12 weeks. There was a trend (P=0.0984) towards a shorter in-patient stay of 1 day for the physiotherapy group [mean 6.50 days (S.D. 2.0)] compared with the acupuncture group [mean 7.77 days (S.D. 3.96)]. Conclusions. We have demonstrated that patients with severe knee osteoarthritis can achieve a short-term reduction in OKS when treated with acupuncture. However, we failed to demonstrate any other clinically or statically significant effects between the groups. Both interventions can be delivered effectively in an out-patient group setting at a district general hospital. Further study is needed to evaluate the combined effects of these treatments.