Does Auricular Acupoint-Related Therapy Enhance Rehabilitation After Total Knee Arthroplasty? A Systematic Review and Network Meta-Analysis.

BACKGROUND: Although auricular acupoint-related therapy (AART) is increasingly used for postoperative rehabilitation after total knee arthroplasty (TKA), evidence comparing the effectiveness of different AART modalities remains limited. This study aimed to evaluate the efficacy and safety of AART through a systematic review and network meta-analysis (NMA). METHODS: We performed a systematic review and NMA of randomized controlled trials (RCTs) from multiple Chinese and English databases, from inception to June 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane ROB-2 tool and evidence quality with GRADE. Pairwise comparisons and NMA were conducted using RevMan 5.4 and R software. RESULTS: Twenty-four RCTs involving 1790 patients were included. Compared with routine rehabilitation, AART significantly reduced resting pain scores on postoperative day 1 (mean difference [MD] = -0.38) and day 3 (MD = -0.61) and improved movement-evoked pain on days 3 and 7. AART also enhanced knee function (Hospital for Special Surgery scores), increased active range of motion, and reduced complications such as vomiting, dizziness, and urinary retention. NMA suggested that auricular acupressure combined with Chinese medicine transdermal therapy may be the most effective intervention for early resting pain. Of note, the certainty of evidence for most outcomes was low or very low, and the findings should be interpreted with caution in clinical practice, serving only as preliminary reference rather than definitive clinical guidance. CONCLUSION: AART may serve as an effective non-pharmacological adjunct in multimodal rehabilitation after TKA, particularly for acute pain relief, functional recovery, and complication reduction. High-quality trials are needed to confirm these findings.