Efficacy of intravenous and periarticular corticosteroids for pain relief in knee arthroplasty

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Created On: 02/09/2023

A randomized controlled trial was conducted to compare the effectiveness of intravenous corticosteroids, periarticular corticosteroids, and a combination of both in terms of pain alleviation and functional recovery following total knee arthroplasty (TKA).

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Key take away

During total knee arthroplasty, intravenous corticosteroids and combination of intravenous and periarticular corticosteroids provide comparable pain relief.

Background

Method

A total of 178 individuals who underwent primary unilateral TKA were initially included in the study. However, 2 patients declined to participate, 2 patients due to a history of peptic ulcer, 4 patients due to their hepatitis B status, and 6 subjects were excluded due to alterations in the surgical technique.

The remaining patients were randomly assigned in a 1:1:1:1 ratio to one of four treatment groups: placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of both intravenous and periarticular corticosteroids (IVSPAS).

Result

During the initial 48 and 72 hours following the operation, the IVSPAS group exhibited notably lower pain scores at rest compared to the P group. Furthermore, the IVS and IVSPAS groups demonstrated substantially lower pain scores during movement than the P group within the first 24, 48, and 72 hours. Additionally, on the third day after the surgery, the IVSPAS group displayed a significantly improved flexion range in the knee that was treated compared to the P group.

On both the second and third postoperative days, the IVSPAS group demonstrated higher quadriceps power compared to the P group. Additionally, within the initial three days after the surgery, patients in the IVSPAS group were able to walk a significantly greater distance than those in the P group. Moreover, the IVSPAS group achieved a higher score on the Elderly Mobility Scale in comparison to the P group.

Conclusion

Both IVS and IVSPAS treatments resulted in comparable pain relief, but the IVSPAS treatment exhibited significantly superior rehabilitation outcomes compared to placebo. These findings offer valuable insights into pain management and postoperative rehabilitation strategies for individuals undergoing TKA.