The Effect of Acupressure Combined with Physiotherapy on Post-Surgical Pain Reduction, Joint Mobility, and Functional Recovery in Elderly Patients Following Knee or Hip Arthroplasty

Abstract

Background: Older adults recovering from knee or hip arthroplasty often experience movement-evoked pain that limits participation in physiotherapy and increases opioid exposure. Non-pharmacological adjuncts that are brief and feasible at bedside are needed to optimize early rehabilitation (1–4). Objective: To determine whether adding a brief, standardized acupressure protocol to early postoperative physiotherapy reduces pain and improves function in elderly arthroplasty patients. Methods: In a pragmatic, assessor-blinded randomized trial, adults ≥65 undergoing primary TKA/THA received enhanced-recovery physiotherapy with multimodal analgesia, with or without a 15-minute nurse-delivered acupressure protocol (auricular Shenmen/Knee-Hip/Thalamus; limb LI4, ST36, SP6; GB34 for TKA or GB29 for THA) immediately before physiotherapy on POD1–5. The primary outcome was average mobilization pain (0–10 NRS) over POD1–3; secondary outcomes included rest pain, daily opioid use (OME), discharge ROM, Timed Up-and-Go (TUG), length of stay, and adverse events. Results: Among 124 analyzed participants, acupressure plus physiotherapy reduced mobilization pain (−1.1 NRS, 95% CI −1.6 to −0.6; p<0.001), rest pain (−0.6, −1.0 to −0.2; p=0.004), and daily OME (−38 mg, −58 to −18; p<0.001); improved TKA knee flexion (+8°, 4 to 12; p<0.001), THA hip flexion (+6°, 2 to 10; p=0.003), and TUG (−2.8 s, −4.1 to −1.5; p<0.001); and did not change length of stay. No serious adverse events occurred. Conclusion: A brief, nurse-delivered acupressure protocol preceding physiotherapy enhances early analgesia and function after arthroplasty without safety concerns, supporting adoption within enhanced-recovery pathways.