Efficacy and Safety of Electroacupuncture for Pain Alleviation in Post-Total Knee Arthroplasty Patients: A Systematic Review and Meta-Analysis.

BACKGROUND Postoperative pain following total knee arthroplasty (TKA) is a substantial clinical challenge, often complicating recovery. Electroacupuncture (EA) has garnered interest as a potential intervention, yet its definitive efficacy and safety profile in the context of TKA remain subjects of ongoing academic debate, necessitating a systematic synthesis of existing evidence. MATERIAL AND METHODS This meta-analysis systematically evaluated the impact of EA on post-TKA pain. A comprehensive literature search was conducted across 8 databases up to July 20, 2025. Statistical analysis of included randomized controlled trials (RCTs) was performed using Review Manager 5.3.0. Sixteen RCTs involving 1142 patients were ultimately included, assessing pain scores, biochemical markers, rescue analgesic use, and adverse events. RESULTS The analysis demonstrated that EA significantly reduced resting pain on postoperative days 1, 3, and 7, and movement-related pain throughout the first postoperative week (all P<0.00001). EA also significantly increased ß-endorphin levels and decreased prostaglandin E2 levels (P<0.00001). Furthermore, EA application led to a reduction in rescue analgesic requirements (RR=0.46, P=0.01) and a lower incidence of adverse events (RR=0.45, P=0.002). The certainty of the evidence for these outcomes ranged from moderate to very low. CONCLUSIONS This meta-analysis provides supportive evidence that EA can be an effective and safe adjunctive therapy for mitigating pain and reducing analgesic reliance after TKA, particularly during the initial postoperative week. However, the conclusions are tempered by the limited quality of some included studies, underscoring the necessity for further rigorously designed, high-quality RCTs to fortify these findings.