Does acupuncture help with knee and hip osteoarthritis?

Health Professional

Does acupuncture help with knee and hip osteoarthritis?

I am often asked if I "believe" in acupuncture. I believe in helping patients. I believe in diagnosing problems and then offering effective, lasting treatments that allow my patients to return to a full, active, pain-free life. If acupuncture helps in this regard, I think it is a positive contribution.

I trained in acupuncture at the UCLA Helms Medical Acupuncture Course and offer it to certain patients who I think would benefit from it. I believe acupuncture is helpful in certain scenarios. But does acupuncture work for the pain and decreased function associated with knee and hip osteoarthritis?

There is some scientific literature suggesting that the use of acupuncture in the treatment of knee and hip osteoarthritis may be beneficial. In 2006, Witt et al. published a study in Arthritis and Rheumatism in which the authors found that acupuncture plus standard care was "associated with a marked clinical improvement in patients with chronic osteoarthritis-associated pain of the knee or hip" when compared with no acupuncture. These results lasted for 6 months.

In 2005, Witt et al. published in The Lancet their findings that after 8 weeks of treatment, patients who received acupuncture had less pain and more joint function than patients treated with either minimal acupuncture (in which needles were inserted into non-acupuncture points) or no acupuncture. This benefit, however, was found to decrease over time and by 52 weeks there was no difference in the acupuncture and minimal acupuncture groups.

In 2006, Scarf et al. published in Annals of Internal Medicine that acupuncture was more effective than no acupuncture for knee osteoarthritis, but not more effective than sham acupuncture (which consisted of inserting acupuncture needles into non-traditional acupuncture points, similar to the "minimal acupuncture" condition in Witt's study above). This, of course, raises the question of whether acupuncture, or the simple act of inserting needles anywhere into the body, or placebo is responsible for the clinical gains observed from acupuncture intervention. Note that while a placebo is often thought to be a "sugar pill," it can be any medical intervention, including surgery, that the patient believes to be therapeutic but which does not carry any inherent physiologic benefit.

In the end analysis, at present, we can best say that more research is needed to determine if, and in what specific circumstances, acupuncture may be helpful for the treatment of hip and knee osteoarthritis.

In my personal experience, I have anecdotally seen enough patients make significant gains with acupuncture to continue offering it to patients for whom I think it would be particularly beneficial. However, it is important to not lose the forest for the trees. We have a lot of other very effective treatments for hip and knee osteoarthritis. I do not believe that acupuncture should be the only treatment for knee and/or hip osteoarthritis. acupuncture as part of a comprehensive approach that includes diet modification, exercise, and possibly supplements, may be appropriate. Acupuncture may also be used in conjunction with other more aggressive medical treatments including medications, injections, and even surgery.

Is acupuncture right for you?
Only you and your doctor can determine if acupuncture might be helpful for you and your symptoms. I would encourage you to speak with your doctor about it. Research reveals that many patients pursue acupuncture without discussing this option with their medical doctors. I feel strongly that this is a mistake. Today, most medical doctors are increasingly open and well-informed about "alternative treatments" such as acupuncture. If you are considering acupuncture, or have questions about it, talk to your doctor.

References and suggested further reading:
Berman BM, Singh BB, Lao L, Langenberg P, et al. "A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee." Rheumatology (Oxford) 38:346-54, 1999

Christensen BV, Iuhl IU, Vilbek H, et al. "Acupuncture treatment of severe knee osteoarthrosis. A long-term study." Acta Anaesthesiol Scand. 36:519-25, 1992

Ezzo J, Hadhazy V, Birch S, Lao L, et al. "Acupuncture for osteoarthritis of the knee: a systematic review." Arthritis Rheum 44:819-25, 2001

Fink MG, Wipperman B, Gehrke A. "Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip." Complement. Ther. Med. 9(2):82-9, 2001

Haslam R. "A comparison of acupuncture with advice and exercises on the symptomatic treatment of osteoarthritis of the hip - a randomized controlled trial." Acupuncture in Medicine 19(1): 19-26, 2001

Hay E, Barlas P, Foster N, et al. "Is acupuncture a useful adjunct to physiotherapy for older adults with knee pain?: the "acupuncture, physiotherapy and exercise" (APEX) study BMC Musculo Disorders 5:31, 2004

Molsberger A, Bowing G, Jensen K, Lorek M. "Acupuncture treatment for the relief of gonarthrosis pain - a controlled clinical trial." Der Schmerz 8:37-42, 1994

Scharf HP, Mansmann U, Sreitberger K, et al. "Acupuncture and Knee Osteoarthritis." Ann of Intern Med. 145:12-20 2006

Streitberger K, Witte S, Mansmann U, et al. "Efficacy and safety of acupuncture for chronic pain caused by gonarthrosis: a study protocol of an ongoing multi-centre randomized controlled clinical trial. BMC Complement Altern Med. 4:6, 2004

Tillu A, Tillu S, Vowler S. "Effect of acupuncture on knee function in advanced osteoarthritis of the knee: a prospective, non-randomised controlled study." Acupunct Med 20:19-21, 2002

Usichenko TI, Kuchline S, Witstruck T, et al. "Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial." CMAJ 176(2):179-833, 2007

Vas J, Mendez C, Perea-Milla E, et al. "Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomized controlled trial." BMJ, 329:1216, 2004

Witt C, Brinkhaus B, Jena S, et al. "Acupuncture in patients with osteoarthritis of the knee: a randomized trial." BMJ, 366:136-143, 2005

Witt CM, Susanna J, Brinkhauss B, et al. "Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm." Arthitis & Rheumatism, 54(11)3485-3493, 2006