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

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.

Epidural Anesthesia versus General Anesthesia for Total Knee Arthroplasty: Influences on Perioperative Cognitive Function and Deep Vein Thrombosis

“…For osteoarthritis, a common orthopedic disease with a sharp increase in the number of resulting fractures, TKA is undoubtedly an ideal treatment [ 20 ]. TKA is mostly performed in the elderly who are at an increased risk of perioperative cognitive dysfunction due to poor physical condition and fragile physiological function of the nervous system [ 21 ]. On the other hand, TKA patients may have varying degrees of coagulation function changes, which is one of the pathological causes of DVT [ 22 ].…”

Effects of electroacupuncture on postoperative cognitive dysfunction and its underlying mechanisms: a literature review of rodent studies

“…A systematic review of five randomized controlled trials has shown improvements in POCD with acupuncture, although the findings are often limited by biases in methodological quality ( Kim et al, 2019 ). Furthermore, a meta-analysis focused on the use of EA for preventing POCD in older adults who have undergone hip or knee arthroplasty has highlighted that EA pretreatment can be an effective intervention for improving cognitive outcomes ( Ou et al, 2021 ). In recent years, an increasing body of research has revealed the positive effects of EA in either preventing or addressing postoperative cognitive deficits observed in animal models.…”

Electroacupuncture pretreatment protects against anesthesia/surgery-induced cognitive decline by activating CREB via the ERK/MAPK pathway in the hippocampal CA1 region in aged rats

“…Clinically and experimentally, electroacupuncture (EA) exerts preventive effects against cognitive dysfunction in POCD models by controlling stimulation frequency and intensity [ 12 , 13 ]. Our group has previously found that EA improves cognitive decline following spine surgery in elderly patients [ 14 ].…”