Cryotherapy ranks highest for early pain relief after total knee arthroplasty in network meta-analysis

ObjectiveThis study aims to perform a network meta-analysis (NMA) to evaluate and compare the effects of various physical therapy modalities in mitigating early postoperative pain following total knee arthroplasty (TKA).MethodsThis systematic review and NMA was conducted according to PRISMA-NMA guidelines. A comprehensive literature search was conducted across multiple databases, including PubMed, SPORTDiscus, The Cochrane Library, Embase, Web of Science, CINAHL Plus and China National Knowledge Infrastructure, to identify randomized controlled trials (RCTs) assessing the effects of eight physical therapy modalities on early postoperative pain in patients with TKA. Data were synthesized using a frequentist framework, and the outcome was pain reduction, assessed using validated pain scales such as the Visual Analogue Scale.ResultsA total of 42 RCTs involving 3,165 participants were included. The NMA demonstrated that electroacupuncture, manual lymphatic drainage (MLD), kinesio taping and cryotherapy all significantly alleviated early postoperative pain following TKA compared to controls. Effect sizes [standardized mean differences (SMDs)] ranged from −0.57 [95% confidence interval (CI): −1.12 to −0.01] for MLD to −0.98 (95% CI: −1.50 to −0.45) for cryotherapy. Among these physical therapy modalities, cryotherapy showed the highest probability of being ranked among the more effective interventions (Surface under the cumulative ranking curve = 88.0%), followed by kinesio taping (83.1%) and electroacupuncture (64.0%). Among these interventions, electroacupuncture (SMD = −0.59, 95% CI: −1.19 to 0.00), kinesio taping (SMD = −0.86, 95% CI: −1.54 to −0.18) and cryotherapy (SMD = −0.95, 95% CI: −1.59 to −0.31) demonstrated significant pain reduction compared to continuous passive motion. However, the overall certainty of evidence ranged from low to very low for most comparisons.ConclusionThis NMA suggests that cryotherapy may be the most effective physical therapy modality for early postoperative pain relief after TKA, followed by kinesio taping and electroacupuncture. However, these findings should be interpreted with caution due to the overall low to very low certainty of evidence and potential risk of bias in the included studies. Further high-quality RCTs are needed to confirm these results and strengthen the evidence base for clinical decision-making.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024518900 identifier CRD42024518900.