Efficacy of Osteopathic Manipulative Treatment for Postoperative Recovery Following Total Knee Arthroplasty: A...

Total knee arthroplasty (TKA) is widely regarded as one of the most common and successful orthopaedic procedures in the United States, specifically in regard to the treatment of end-stage osteoarthritis of the knee. However, pain and range of motion (ROM) restrictions continue to burden patients in the acute postoperative period following TKA. Osteopathic manipulative treatment (OMT) is a safe and non-invasive therapy utilized by osteopathic physicians to treat and heal dysfunctions of the musculoskeletal system. The effectiveness of OMT in enhancing postoperative recovery remains a subject of ongoing debate. This meta-analysis investigates the efficacy of OMT in creating a difference in pain, measured on the numeric rating scale, and ROM in flexion in the acute postoperative period following TKA. Three randomized controlled trials (RCTs) with a total of 153 patients, 74 of them receiving OMT and 79 not receiving OMT, were identified and included in this meta-analysis. In regard to postoperative pain, the mean difference between OMT and non-OMT groups, using the random-effects model, was -0.59 (-1.96; 0.78). This mean difference favors a slightly lower postoperative pain level in the OMT group; however, this fails to reach statistical significance. Moderate to high heterogeneity was appreciated between studies (I²=50.8%), but this failed to reach statistical significance (p=0.1309). In regard to postoperative ROM in flexion, the mean difference between OMT and non-OMT groups, using the random-effects model, was 5.57 (-15.57; 26.70). This mean difference favors a slightly greater postoperative ROM in the OMT group; however, this fails to reach statistical significance. High heterogeneity was appreciated between studies (I²=89.9%), which proved to be statistically significant (p<0.0001). Given the overall similarity in patient recovery metrics, the effectiveness of OMT in improving postoperative pain and ROM following TKA cannot be proven at this time. However, the potential for clinical significance and minor improvements should be considered. Additional high-quality RCTs and comprehensive meta-analyses are needed to further define the role of OMT in the postoperative period following orthopaedic procedures.