Effect of Electroacupuncture Prestimulation on Early Cognitive Function After Hip Replacement in Elderly Patients and Its Mechanism

Abstract

Background

Perioperative neurocognitive disorders (PND), including delirium and postoperative cognitive dysfunction (POCD), are common and debilitating complications in elderly patients undergoing total hip arthroplasty (THA). Electroacupuncture (EA) has shown potential in modulating neuroinflammation and oxidative stress, yet its preoperative efficacy in preventing cognitive decline remains unclear.

Methods

A single-center, randomized, patient- and assessor-blinded, sham-controlled trial was conducted with 150 patients aged 65 and older undergoing elective THA. Participants were assigned to receive EA pretreatment at acupoints Baihui (GV20) and Dazhui (GV14), or sham stimulation. The primary outcome was the change in Montreal Cognitive Assessment (MoCA) score from baseline to postoperative day 3 (POD3), a timepoint corresponding to the typical peak period of early postoperative cognitive decline. Early PND was predefined as a ≥ 2-point decline in MoCA score at POD3 compared with baseline. Secondary outcomes included delirium incidence, serum biomarkers (S100β, NSE, IL-1β, IL-6, TNF-α, cortisol), pain scores, opioid consumption, quality of recovery (QoR), and cognitive assessments at 1, 3, and 6 months after surgery.

Results

EA significantly attenuated cognitive decline (ΔMoCA −1.1 ± 2.0 vs −2.8 ± 2.5; p = 0.002) and reduced the incidence of early PND (≥2-point MoCA decline at POD3) (13.3% vs 28.0%; p = 0.028). EA also lowered postoperative biomarkers of neuronal injury and inflammation, including S100β, NSE, and pro-inflammatory cytokines, while improving pain control, reducing opioid consumption, and enhancing QoR. No serious adverse events occurred, and blinding integrity was maintained.

Conclusion

Preoperative EA at Baihui and Dazhui significantly improved early cognitive outcomes and reduced neuroinflammation in elderly patients undergoing THA. EA represents a feasible, non-pharmacological adjunct to perioperative care aimed at reducing early PND, with a favorable safety profile.