Combination effect of high-dose preoperative and periarticular steroid injection in total knee arthroplasty: A randomised controlled study

Abstract

Introduction: Postoperative pain remains a major obstacle to recovery after total knee arthroplasty (TKA). Periarticular corticosteroid in local infiltration analgesics and high-dose intravenous corticosteroid have individually been shown to improve pain control. However, potential interactions between them have not been investigated. We aimed to evaluate any combination effect of both routes of corticosteroid in TKA. Methods: This was a double-blind paired randomised controlled study involving one-stage bilateral TKA. All received 16 mg dexamethasone intravenously before spinal anaesthesia. One knee was randomised to receive periarticular 40 mg triamcinolone, in addition to standard local infiltration analgesics. For each patient, one knee was affected by intravenous steroid only (IVS group), while the other was under the combined effect of intravenous and periarticular steroid (IVPAS group). Knee pain, Southampton wound, and functional scores were documented up to 1 year and compared between knees of the same patient. Results: A total of 44 patients were included. Patients in the IVPAS group showed significantly lower visual analogue scale score during activity from day 1 to 6 weeks (p<0.05) and a larger active range of movement from day 2 to 4 (p<0.05). Patients in the IVPAS group were able to achieve active straight leg raise earlier than patients in the IVS group (1.6 vs 2.3 days, p<0.05). There were no differences in Southampton wound and functional scores (Knee Society Knee score and Oxford Knee scores) up to 1 year after surgery. Conclusion: To the best of our knowledge, this is the first report to demonstrate a combination effect between intravenous and periarticular steroids in TKA. Combining corticosteroids from both routes improved pain control and recovery with no increase in wound complications.