Electroacupuncture for the Prevention of Postoperative Cognitive Dysfunction Among Older Adults Undergoing Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Liang Ou; Zhen Shen; Tiantian Zhang; Zehua Chen; Lin Zhang; Daoqing Xu; Dezhong Kong; Qi Qi; Yanchang Huang; Weichen Huang; Yingfu Meng

doi:10.3389/fmed.2021.778474

Electroacupuncture for the Prevention of Postoperative Cognitive Dysfunction Among Older Adults Undergoing Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Front Med (Lausanne). 2022 Jan 4:8:778474. doi: 10.3389/fmed.2021.778474. eCollection 2021.

Authors

Liang Ou¹, Zhen Shen², Tiantian Zhang³, Zehua Chen⁴, Lin Zhang¹, Daoqing Xu¹, Dezhong Kong¹, Qi Qi¹, Yanchang Huang¹, Weichen Huang¹, Yingfu Meng¹

Affiliations

¹ Department of Orthopedics, The Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China.
² Department of Orthopedics, Kunming Municipal Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China.
³ The Graduate School, Hunan University of Chinese Medicine, Changsha, China.
⁴ The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.

Abstract

Background: Postoperative cognitive dysfunction (POCD) is a common surgical complication in elderly patients undergoing hip and knee replacement. Electroacupuncture (EA) may have a protective effect on postoperative cognitive function, but relevant evidence remains uncertain. Objective: To systematically evaluate the evidence of EA for the prevention of POCD after total joint arthroplasty. Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and Chinese Biomedical Literature Database (CBM) databases were searched until May 1, 2021. Randomized controlled trials (RCTs) in which patients undergoing hip and knee replacement pretreated with EA for preventing POCD were included. The risk of bias was assessed by the Cochrane Collaboration tool. Meta-analysis was performed using Review Manager version 5.4. Results: A total of 11 RCTs with 949 patients were identified. Meta-analysis showed that compared with controls, EA pretreatment significantly reduced the incidence of POCD at 1, 3, and 7 days and 3 and 6 months after the operation. EA was also superior in improving the Mini-Mental State Examination (MMSE) scores on the third postoperative day, but not on the first postoperative day. Neuron-specific enolase (NSE) and interleukin-1β (IL-1β) in the EA group were significantly lower than that in the control group. There was no difference in S100β between the EA group and the control group. Compared to the control group, tumor necrosis factor-α (TNF-α) levels were not significantly lower in the EA group at postoperative hour 0, while significantly decreased at postoperative hours 24 and 48. Conclusion: Our results suggest that EA pretreatment is an effective adjunctive therapy for reducing the incidence of POCD for patients receiving total joint replacement surgery. Its effect was embodied in improving the MMSE scores and NSE, IL-1β, and TNF-α levels, whereas it had no significant effect on S100β levels. Meanwhile, the benefits of EA for improving POCD need further strengthening and support from more large-scale, high-quality, and good-homogeneity RCTs. Systematic Review Registration: https://osf.io/xb3e8.

Keywords: arthroplasty; elderly; electroacupuncture; meta-analysis; postoperative cognitive dysfunction; prevention; systematic review.

Publication types

Systematic Review