Francesca Galiano
16/01/2023 - Last update 25/05/2023

YaQun Zhou, Justin Chin, Abigail Evangelista, Blake Podger, Peter J. Wan, Christine M. Lomiguen | Year 2022

Inhibiting the Musculoskeletal Pathological Processes in Post-knee Replacement Surgery With Osteopathic Manipulative Treatment: A Systematic Review


Total knee arthroplasty

Type of study:

Systematic review

Date of publication of the study’:



Purpose of the study

  • Objective: to evaluate the efficacy of OMT on pathological musculoskeletal processes following total knee replacement surgery
  • Measured outcomes:
    • Primary: evaluation of Hospital Stay, Pain Control, Activities of Daily Living (ADL) and mobility through Range of Motion (ROM)


  • Articles analyzed: 18
  • Search string: combinazione dei seguenti termini: “post-operative”, “knee arthroplasty”, “total knee replacement” e “osteopathic medicine”
  • Criteria of inclusion: all articles published in the last 30 years
  • Criteria of exclusion: commentaries without scientific data, studies not actually aimed at evaluating the OMT, studies whose full text could not be found, studies not in English

Characteristics of the studies

  • 10 prospective studies
  • 1 case report
  • 2 cross-sectional studies
  • 2 systematic reviews
  • 1 case-control study
  • several studies did not concern OMT


  • Number in the smallest study: 33 people
  • Number in the biggest study: 8.325 people
  • Total: at least 10,000 people were scrutinized

Interventions and evaluations

  • Evaluation of Hospital Stay, Pain Control, ADL and ROM
  • OMT: variable according to study


  • Primary outcomes: the major problems encountered as a result of arthroplasty were mobility problems (9 studies), pain (9 studies), difficulties in ADL (8 studies) and Length of Stay (5 studies)

One study reported the usefulness of OMT in improving the ability to climb stairs and walk, such effects were linked to an increased patients’ satisfaction and consequent faster recovery.

A randomized controlled trial reported an ADL recovery rate 20% higher in the OMT group than in the control group, while another randomized controlled trial reported no benefit whatsoever. However, in this second study the OMT was carried out by a student not yet fully trained.

Preliminary results did not show the usefulness of OMT in reducing post-arthroplasty edema


There is not enough evidence to determine whether or not OMT can actually be useful to manage knee arthroplasty complications.

More rigorous studies are needed, with more defined and standardized outcomes and, potentially, with repeatable OMT protocols.

The review of Osteopedia

By Marco Chiera

Strengths: an attempt to analyze all the studies in the literature of the last 30 years.

Limits: inclusion of studies not concerning OMT; not very consistent presentation (for example, the description of what the OMT is and of what it can do appears in the paragraph dedicated to the ROM of the Discussion section); there is no in-depth discussion on the included studies; the study appeares more as a hypothesis paper, where the general osteopathic literature is cited to hypothesize that perhaps OMT can be useful in case of arthroplasty.

The evaluation of the quality of the studies, the description of the outcomes, interventions and controls of the various and other elements of a systematic review are missing.

Are you an osteopath?

Register and enjoy the membership benefits. Create your public profile and publish your studies. It's free!

Register now

School or training institution?

Register and enjoy the membership benefits. Create your public profile and publish your studies. It's free!

Register now

Do you want to become an osteopath? Are you a student?

Register and enjoy the membership benefits. Create your public profile and publish your studies. It's free!

Register now