Arthritis

Updated 03 February 2016

Acupuncture an alternative to knee surgery

A study finds that acupuncture offers a low cost alternative to knee surgery for osteoarthritis.

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The researchers base their findings on 90 patients with knee osteoarthritis, who were referred for group acupuncture to two knee pain clinics in St Albans, Hertfordshire, in 2008 and subsequently monitored for two years.

The clinics were set up in 2008 for NHS patients, and run in two GP practices by specially trained acupuncture nurses, to see whether this could improve care, while reducing costs, and offer a viable alternative to referrals for expensive knee replacement surgery.

This type of surgery works well, and provides value for money, say the authors. But it is not suitable for everyone, and as many as one in seven patients experience severe pain a few years after the procedure.

Read: Treating knee pain 

It also costs approximately R65 000 a pop, and knee osteoarthritis is common, causing significant pain in 17% of the UK population over the age of 50, they add.

How the study was done

Out of 114 patients who were offered acupunture for osteoarthritic knee pain in 2008, 90 accepted and were treated in the clinics. Their average age was 71. All the patients referred to the clinics had severe symptoms - constant pain, including at night, and inability to walk far - and would have been eligible for surgery.

Fifty patients said they would be prepared to have surgery; four said they would only have the operation as a last resort; and 29 said they did not want surgery.

They were given acupuncture once a week for a month after which the frequency was reduced to a session every six weeks.

Read: How effective are steroid shots and ozone injections for knee arthritis 

Forty one patients were still attending the clinics after a year, and 31 were still receiving treatment after two years. Each patient received an average of 16.5 treatments.

A validated score (MYMOP), used to measure symptom control, functional capacity, and wellbeing, showed clinically significant improvements in pain levels, stiffness, and functional capacity after one month of treatment. These improvements continued throughout the two year monitoring period, as assessed by MYMOP at six monthly intervals.

Based on the assumption that only two thirds of patients would take up an offer of acupuncture, the authors calculate that the service could save the NHS around R1 301 457 a year. Each treatment costs the NHS R265.

Read: Preventing knee pain 

The authors also looked at the rates of total knee replacements for the three neighbouring commissioning groups after the service had been introduced.

They found that the group that had commissioned the service, which includes 13 general practices serving 180,000 patients, had the lowest rate, and that this was 10% lower than one of the other groups by 2011.

Read more:

70% of adults get osteoarthritis 

7 everyday things that could be damaging your joints  

Future knee implants will be made by silkworms

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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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