Acupotomy combined with oral pharmacotherapy for osteoarthritis: A systematic review and Bayesian network meta-analysis

Background Osteoarthritis (OA), a prevalent degenerative joint disease causing pain and disability, burdens global health. Acupotomy offers a minimally invasive alternative to surgery but faces limitations like variable efficacy. Combining acupotomy with oral pharmacotherapy (conventional or herbal medicine) may optimize outcomes through synergistic effects. Objective To systematically evaluate the efficacy and safety of acupotomy combined with oral medication for the treatment of osteoarthritis through a Bayesian network meta-analysis (NMA). Methods This study followed PRISMA-P guidelines. Randomised controlled trials (RCTs)were selected through 6 databases. Primary outcomes included overall effective rate, WOMAC score, VAS pain score, and adverse events. Results 31 RCTs (3323 patients and 8 interventions) included. NMA revealed that Combinations outperformed other interventions in most comparisons. SUCRA represents the probability that an intervention ranks among the best. Notably, “acupotomy + herbal medicine” consistently ranked among the best across all three outcomes. Conclusion Acupotomy combined with oral medications demonstrated superior clinical efficacy and significant application potential. In clinical, acupotomy combined with conventional medications (e.g., NSAIDs) may be prioritised to alleviate acute symptoms, whereas acupotomy combined with herbal medicine shows more promising potential in long-term functional recovery. Treatment protocols should be tailored to individual patient conditions to maximise therapeutic outcomes.