Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2022; 13(10): 932-939
Published online Oct 18, 2022. doi: 10.5312/wjo.v13.i10.932
Traditional Chinese medicine ointment combined with tuina therapy in treatment of pain and swelling after total knee arthroplasty
Liang Xing, Hui-Rong Xu, Qing-Lin Wang, Hua Kong, Hua Zhang, Jing Tian, Ying Ding, Ru-Xin Yang, Lei Zhang, Bo Jiang
Liang Xing, Hua Kong, Hua Zhang, Ru-Xin Yang, Lei Zhang, Bo Jiang, Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
Hui-Rong Xu, Department of Nursing, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
Qing-Lin Wang, Department of Vascular Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
Jing Tian, Department of Orthopedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
Ying Ding, Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
Author contributions: Jiang B contributed to the conceptualization and data curation; Xu HR, Wang QL, Kong H, Zhang H, Tian J, Ding Y, Yang RX and Zhang L contributed to project administration; Xing L contributed to writing, including review and editing, and project administration; and all authors read and approved the final manuscript.
Supported by the Research Project of Wangjing Hospital, China Academy of Chinese Medical Sciences, No. WJYY2020-11.
Institutional review board statement: This study was approved by the Ethics Committee of the Wangjing Hospital, China Academy of Chinese Medical Sciences.
Clinical trial registration statement: The authors declare that this study is original, but not register yet.
Informed consent statement: All patients signed an informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Jiang, MD, Attending Doctor, Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, No. 6 Zhonghuan South Road, Wangjing, Chaoyang District, Beijing 100102, China. arthrostudent@gmail.com
Received: July 12, 2022
Peer-review started: July 12, 2022
First decision: August 21, 2022
Revised: September 5, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 18, 2022
Processing time: 96 Days and 20.8 Hours
Abstract
BACKGROUND

The most effective treatment for knee joint pain is total knee arthroplasty (TKA), but the risk of pain and swelling in patients after surgery is high. Ice application, ankle pump exercise and non-steroidal anti-inflammatory painkillers are the primary clinical treatments after surgery. However, long-term use of non-steroidal anti-inflammatory pain relievers can easily cause gastrointestinal damage. Traditional Chinese medicine (TCM) ointments and tuina therapy integrate TCM and manipulation, which effectively promotes the penetration of TCM into the skin lesions, improves local blood circulation and inflammatory reaction and has good long-term effects on patients.

AIM

To evaluate the efficacy of TCM ointment combined with tuina therapy in the treatment of pain and swelling after TKA.

METHODS

The randomized controlled clinical trial enrolled 80 patients who underwent TKA via the same procedure. The patients were randomly divided among the treatment group (n = 40) and the control group (n = 40). The control group was given an analgesia pump in addition to oral painkillers as the postoperative intervention. The treatment group received TCM ointment with tuina therapy in addition to the analgesia pump and oral painkillers in the postoperative period. The following variables were recorded 3 d before surgery and 3 d, 7 d and 14 d after surgery: Visual analogue scale (VAS) score; skin temperature; circumferences at 15 cm above and below the patella; maximum active knee flexion angle; and the knee injury and Osteoarthritis Outcome score (KOOS).

RESULTS

After treatment, VAS was significantly lower in the treatment group than the control group at 7 d (t = 7.536, P < 0.001) and 14 d (t = 8.563, P < 0.001). The skin temperature of participants in the treatment group was significantly lower than that in the control group at 7 d (t = 2.968, P = 0.004) and 14 d (t = 4.423, P < 0.001). The circumference values of the two positions in the treatment group were lower than those in the control group at 7 d [t = 2.315, P = 0.023 (above); t = 2.121, P = 0.037 (below)] and 14 d [t = 2.374, P = 0.020 (above); t = 2.095, P = 0.039 (below)]. After 14 d of treatment, the maximum active knee flexion angle and KOOS of the two groups were significantly improved but were significantly higher in the treatment group (P < 0.05 for both).

CONCLUSION

TCM ointment and tuina therapy have significant advantages over standard care in the treatment of pain and swelling after TKA. This additional treatment may improve knee function but additional studies are needed to confirm our observations.

Keywords: Traditional Chinese medicine ointment; Tuina therapy; Total knee arthroplasty; Pain; Swelling

Core Tip: Traditional Chinese medicine (TCM) ointments and tuina therapy integrate TCM and manipulation, which effectively promotes the penetration of TCM into skin lesions, improves local blood circulation and inflammatory reaction, and has a good long-term effect on patients. This study observed and compared several parameters after artificial knee arthroplasty in two groups. The control group received routine care, and the treatment group received routine care as well as a TCM ointment and tuina therapy. All parameters were significantly better in the treatment group, providing evidence that the integrated therapy may improve knee function in the long term.