Pain Relief After Total Knee Arthroplasty with Intravenous and Periarticular Corticosteroid

Abstract

Background:Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both.Methods:This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS).Results:The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036).Conclusions:IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Perioperative Short‐Term Glucocorticoids Do Not Increase Incidence of Complications after Total Joint Arthroplasty in Patients with Rheumatoid Arthritis

“…Total joint arthroplasty represents a highly efficacious intervention for end‐stage hip or knee disease, and perioperative corticosteroids, as part of contemporary multimodal treatment regimens, are often administered in order to relieve postoperative pain, reduce the risk of postoperative complications, and enhance recovery. 1 Numerous randomized controlled trials 2 , 3 and meta‐analyses 4 , 5 , 6 , 7 have consistently demonstrated that perioperative glucocorticoids can significantly reduce postoperative pain, opioid use, nausea, and vomiting without increasing risk of postoperative complications. However, most of these studies have focused on patients with osteoarthritis of hip or knee other than rheumatoid arthritis.…”