Combining of intravenous and periarticular corticosteroid injection in total knee arthroplasty. A paired-randomized controlled study

Abstract

Introduction: Addition of corticosteroid to local infiltration analgesia (LIA) was shown by our group to enhance pain control and rehabilitation after TKA. On the other hand, high dose intravenous corticosteroid was found to reduce pain, in addition to its effect on postoperative nausea and vomiting after TKA. We aim to evaluate any combination effect of intravenous and periarticular steroid in TKA. Methodology: This is a paired-randomized controlled study involving one-stage bilateral TKA patients. All received 16mg dexamethasone intravenously before TKA. LIA containing ropivacaine, ketorolac, adrenaline with or without 40mg triamcinolone was given. Each knee of same patient was randomized to receive LIA with or without steroid. Knee pain, rehabilitation progress, Southampton wound scores, functional scores and complications were documented up to 3 months. Results were compared between knees of same patient. Results and Analysis: 27 patients (54 TKAs) were included. Knees receiving combined intravenous and periarticular steroid showed significant lower visual analogue scale score during activity from day 1 to 7 (p<0.05), shorter time to achieve active straight leg raise (1.7 vs 2.5 p=0.027) and larger passive knee range on day 5 and 7 (p<0.05). All wounds healed with no differences in Southampton scores. No differences in Knee Society knee Score and Oxford Knee Score up to 3 months. Discussion and Conclusion: Combining intravenous and periarticular steroid can improve pain control and recovery after TKA with no increase in adverse effects. This has important clinical significance in setting of fast-track arthroplasty.