The efficacy of transcutaneous electrical nerve stimulation as an adjunctive therapy for perioperative pain management after total knee arthroplasty: an umbrella review.
5 affiliations
- 1Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- 2National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- 3Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China. [email protected].
- 4National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China. [email protected].
- 5Changde First People's Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China. [email protected].
Abstract
Background
Total knee arthroplasty (TKA) is a cornerstone intervention for end-stage knee pathologies, yet acute postoperative pain remains a critical barrier to rehabilitation. Transcutaneous electrical nerve stimulation (TENS), a non-pharmacological adjunct, has potential for pain mitigation, but its efficacy lacks robust evidence from umbrella reviews.Methods
This umbrella review systematically evaluated meta-analyses (MAs) published through September 2025 in PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science. Overlap among primary studies was assessed using the GROOVE tool, and evidence quality was graded via the AMSTAR 2 and GRADE frameworks. This umbrella review is registered on the Prospective Register of Systematic Reviews (PROSPERO) under accession no. CRD420251126630.Results
Eleven MAs were included in this review. The results showed that TENS significantly reduced acute postoperative pain at 24 h (MD = - 0.42, 95% CI - 0.59, - 0.25, P < 0.00001, I² = 0%) and 72 h (MD = - 0.84, 95% CI - 1.17, - 0.52, P < 0.00001, I² = 0%), but no significant difference was observed at 2 weeks (MD = 0.97, 95% CI - 0.66, 2.60, P = 0.24, I² = 91%). Opioid consumption was lower in the TENS group (SMD = - 0.58, 95% CI - 1.06, - 0.11, P = 0.02, I² = 53%). Improvements were also seen in range of motion (SMD = 0.40, 95% CI 0.11, 0.68, P = 0.006, I² = 0%), Hospital for Special Surgery scores (MD = 4.18, 95% CI 2.91, 5.45, P < 0.00001, I² = 0%), and length of hospital stay (SMD = - 0.20, 95% CI - 0.38, - 0.03, P = 0.02, I² = 0%). TENS was associated with a reduced incidence of nausea and vomiting.Conclusions
TENS is an effective adjunct for acute pain management after TKA, reducing opioid use and improving early functional outcomes. Future research should aim to standardize TENS application protocols and evaluate long-term efficacy and safety.
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BibTeX
@article{huang2026efficacy,
title = {{The efficacy of transcutaneous electrical nerve stimulation as an adjunctive therapy for perioperative pain management after total knee arthroplasty: an umbrella review.}},
author = {Meihui Huang and Peiyuan Tang and Ting Wen and Yusheng Li and Bangbao Lu and Xucheng Yang and Wenfeng Xiao and Kai Zhang},
journal = {Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology},
year = {2026},
month = jul,
doi = {10.1186/s10195-026-00957-z},
url = {https://europepmc.org/article/MED/42902059},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The efficacy of transcutaneous electrical nerve stimulation as an adjunctive therapy for perioperative pain management after total knee arthroplasty: an umbrella review.
AU - Meihui Huang
AU - Peiyuan Tang
AU - Ting Wen
AU - Yusheng Li
AU - Bangbao Lu
AU - Xucheng Yang
AU - Wenfeng Xiao
AU - Kai Zhang
PY - 2026
DA - 2026/07/01
JO - Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
DO - 10.1186/s10195-026-00957-z
UR - https://europepmc.org/article/MED/42902059
AB - Background Total knee arthroplasty (TKA) is a cornerstone intervention for end-stage knee pathologies, yet acute postoperative pain remains a critical barrier to rehabilitation. Transcutaneous electrical nerve stimulation (TENS), a non-pharmacological adjunct, has potential for pain mitigation, but its efficacy lacks robust evidence from umbrella reviews.Methods This umbrella review systematically evaluated meta-analyses (MAs) published through September 2025 in PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science. Overlap among primary studies was assessed using the GROOVE tool, and evidence quality was graded via the AMSTAR 2 and GRADE frameworks. This umbrella review is registered on the Prospective Register of Systematic Reviews (PROSPERO) under accession no. CRD420251126630.Results Eleven MAs were included in this review. The results showed that TENS significantly reduced acute postoperative pain at 24 h (MD = - 0.42, 95% CI - 0.59, - 0.25, P < 0.00001, I² = 0%) and 72 h (MD = - 0.84, 95% CI - 1.17, - 0.52, P < 0.00001, I² = 0%), but no significant difference was observed at 2 weeks (MD = 0.97, 95% CI - 0.66, 2.60, P = 0.24, I² = 91%). Opioid consumption was lower in the TENS group (SMD = - 0.58, 95% CI - 1.06, - 0.11, P = 0.02, I² = 53%). Improvements were also seen in range of motion (SMD = 0.40, 95% CI 0.11, 0.68, P = 0.006, I² = 0%), Hospital for Special Surgery scores (MD = 4.18, 95% CI 2.91, 5.45, P < 0.00001, I² = 0%), and length of hospital stay (SMD = - 0.20, 95% CI - 0.38, - 0.03, P = 0.02, I² = 0%). TENS was associated with a reduced incidence of nausea and vomiting.Conclusions TENS is an effective adjunct for acute pain management after TKA, reducing opioid use and improving early functional outcomes. Future research should aim to standardize TENS application protocols and evaluate long-term efficacy and safety.
SN - 1590-9921
SN - 1590-9999
ER -