Acupuncture in TKA? New Study From HSS. Outcome? “Remarkable!”

Would you try to perform a total knee implant using acupuncture as your pain management tool?

One of this country’s leading large joint surgeons and an anesthesiologist at Hospital for Special Surgery (HSS) in New York did just that, using a form of acupuncture that involves electricity—electro-auricular acupuncture—both intra and postoperatively in a total knee arthroplasty (TKA) case.

Their study, “Intraoperative Acupuncture as Part of a Multimodal Analgesic Regimen to Reduce Opioid Usage After Total Knee Arthroplasty: A Prospective Cohort Trial,” appears in the February 14, 2022, edition of Medical Acupuncture.

Lead researcher, anesthesiologist Dr. Stephanie Cheng told OTW, “Ultimately emanating from Chinese medicine and French energetic medicine, electro-auricular acupuncture, works from the concept that the outer portion of the ear is a microsystem that reflects the health of the entire body. While a number of practitioners are using electro-auricular acupuncture, to my knowledge we are the first group to use it intraoperatively and publish in English on this topic.”

Cheng and her team enrolled 41 patients into the study and managed their pain during primary unilateral TKA with neuraxial anesthesia and a standardized, opioid-free intraoperative protocol that included electro-auricular acupuncture. Forty patients completed the study. Twenty six (65%) remained on a low-dose opioid regimen, with 3 (7%) remaining opioid-free for 30 days.

“Our findings were that patients who had the electro-auricular acupuncture had a significantly better chance of maintaining a low-dose opioid regimen compared to those who did not receive the treatment,” Dr. Cheng told OTW. Also, at the 30-day postop mark, all patients had stopped the opioids and 65% of those patients were able to maintain a low-dose opioid regimen—a substantial improvement from the historical baseline of 9%.

Dr. Cheng: “Patients are big fans of the electro-auricular acupuncture as not only does it work well, but there is almost zero risk of infection. HSS orthopedic surgeon Dr. Michael Ast was an early adopter, essentially telling me, ‘Let’s try it out.’ Now he prefers it for all of his total knee surgeries.”

HSS Surgeon: “It’s Remarkable”

Dr. Ast explained to OTW, “Since we instituted acupuncture during surgery, I have been amazed with some of our results. Immediately after surgery, many patients look more lively and energetic in the recovery room, seem to have less nausea and our data supports that they have less pain. At their first post-op visit, it’s remarkable how many patients tell me this was the best anesthesia experience they have ever had. Over the last two years or so, we have seen an influx of new patients specifically seeking out our team because they would like acupuncture incorporated into their surgical experience.”

But certainly Dr. Cheng will need help?

“As part of our Regional Anesthesia Fellowship Program, the fellows are allowed to participate in the integrative medicine tract and get their certification in acupuncture. I currently have two anesthesiologist fellows completing their certification, as well as learning electro-auricular acupuncture alongside me. In addition, we are doing randomized controlled trials and retrospective studies on this treatment. This is only going to grow in popularity.”

New Referral Pattern!

“We are actually seeing a new trend where patients come in and ask for electro-auricular acupuncture. And if by chance I am on vacation, they reschedule! They are actually cold calling the anesthesiology department for this treatment.”