Authors: Rodrigo Núñez-Cortés, PT
Published: Journal of Orthopaedic & Sports Physical Therapy, 2017 Volume:0 Issue:0 Pages:1–24 DOI: 10.2519/jospt.2017.7089

Study Design
Case series.

Background
The purpose of this case series is to describe a combined program of dry needling (DN) and therapeutic exercise in a small group of patients with persistent pain post total knee arthroplasty.

Case Description
Fourteen total knee arthroplasty patients with persistent post-surgical pain and myofascial trigger points non-responsive to treatment with conventional physical therapy or medications received dry needling treatment in combination with therapeutic exercises for four weeks. Dry needling sessions occurred once weekly. Pre- and post-intervention, pain perception was assessed with the visual analogue scale; functional assessments with the WOMAC questionnaire; six-minute walking test; Timed Up and Go test, 30-Second Chair Stand Test and knee joint range of motion.

Outcomes
Patients presented symptoms for 6.3 ± 3.1 months post-operation. Dry needling resulted in significantly decreased pain intensity (55.6 ± 6.6 to 19.3 ± 5.6, p<0.001) and improved WOMAC values for pain (10.1 ± 0.8 to 4.9 ± 1.0, p<0.001), stiffness (5.3 ± 0.4 to 2.4 ± 1.2, p<0.001), and function (36.7 ± 2.0 to 20.1 ± 3.2, p<0.001). Knee flexion increased from 82.7 ± 5.2° to 93.3 ± 4.3° (p<0.001), while joint extension improved from 15.8 ± 2.9° to 5.3 ± 2.4° (p<0.05). The six-minute walking test also showed better post-intervention values (391.4 ± 23.7 m to 424.7 ± 28.4 m, p<0.05). Discussion Dry needling together with therapeutic exercises had clinical and significant functional benefits for patients with chronic post-surgical pain and myofascial trigger points following total knee replacement. Future randomized clinical trials should further investigate the effectiveness of this protocol under similar conditions. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7089 Journal Abstract