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Background: There is no high-quality, evidence-based protocol for the treatment of postoperative fatigue syndrome (POFS) after total joint arthroplasty (TJA) or fracture surgery with Chinese herbal medicine (CHM).
Purpose: The purpose of this study was to explore the efficacy of Chinese herbal medicine in the treatment of postoperative fatigue syndrome after total joint arthroplasty or hip fracture surgery (HFS).
Methods: We searched six databases to obtain randomised controlled trials (RCTs) of Chinese herbal medicine for the treatment of postoperative fatigue syndrome after total joint arthroplasty or HFS. The retrieval time limit was from the establishment of each database to August, 2022. According to the Cochrane Handbook for Systematic Reviews version 5.1, we used RevMan 5.3 to evaluate the quality of the studies. Stata 14.0 software was used to merge and analyze the data. The weighted mean difference (WMD) was the effect estimate for statistical analysis. We also performed subgroup analyses according to different types of surgeries.
Results: A total of 11 RCTs were included in this study, comprising 430 cases in the Chinese herbal medicine group and 432 cases in the control group (CG). The meta-analysis results showed that there was no significant difference in the Brief Profile of Mood States (BPOMS) score (WMD=0.08, 95% confidence interval (CI): -0.29 to 0.45, P=0.688), Christensen Fatigue scale (CHFS) score (WMD = 0.15, 95% CI: -0.09 to 0.39, P=0.214) or Identity-Consequence Fatigue Scale (ICFS) score (WMD=-0.40, 95% CI: -1.84 to 1.05, P=0.589) between the Chinese herbal medicine group and the CG on the first postoperative day.
The use of Chinese herbal medicine significantly reduced the BPOMS score (WMD=-0.85 and WMD=-3.01, respectively), CHFS score (WMD=-1.01 and WMD= -1.45, respectively), and ICFS score (WMD=-3.51 and WMD=-5.26) on postoperative days 3 and 7. Compared with the CG, the Chinese herbal medicine group had significantly increased serum transferrin and IgG levels on postoperative days 3 and 7. The subgroup analysis results suggested that the application of Chinese herbal medicine in hip fracture surgery patients improved fatigue symptoms on postoperative days 3 and 7, while the application of Chinese herbal medicine to treat postoperative fatigue syndrome in total joint arthroplasty patients had great inconsistency in the evaluation of different indicators.
Conclusion: The application of Chinese herbal medicine improved the fatigue status of postoperative fatigue syndrome patients after total joint arthroplasty or hip fracture surgery and increased the levels of transferrin and IgG in serum, which is conducive to promoting the postoperative rehabilitation process of patients. The subgroup analysis results showed that the application of Chinese herbal medicine to intervene in postoperative fatigue syndrome in hip fracture surgery patients had obvious benefits.
Reference: https://pubmed.ncbi.nlm.nih.gov/38031783/