Abstract
Introduction
Total knee arthroplasty is a painful operation. Peri-articular local anesthetic injections reduce post-operative pain and assist recovery. It is inconclusive whether intra-operative injections of peri-articular corticosteroids are of benefit. Clinical Question: In patients with osteoarthritis who are undergoing TKA, does the addition of high or low dose corticosteroid to peri-articular injections of local anesthetic and adrenaline improve post-operative pain and range of motion?
Methods
A prospective, randomized, double-blinded study was undertaken to assess the efficacy of adding peri-articular corticosteroids to intra-operative, peri-articular high volume local anaesthetic in post-operative pain management following TKA. 127 patients were randomised into three groups receiving local anaesthetic alone (control) or either low dose (40 mg) or high dose (80 mg) peri-articular corticosteroid plus local anaesthetic. Primary outcomes included ROM and visual analog pain scores (VAS). Pain was defined as the worst pain lasting for more than 20 minutes, measured at both rest (RVAS) and during activity (AVAS).
Results
There were no significant between-group differences for age, body mass index (BMI), pre-operative ROM or pre-operative pain scores. There were no statistically significant differences in primary or secondary outcomes between the groups. This was the case at all time points. Analysis of non-significant trends demonstrated a 17.7% reduction in RVAS between the control group and high dose steroid group at 12-weeks. This trend was also apparent at 2 and 6 weeks. There was no trend towards decreased total morphine equivalents (or any other secondary outcome) between the control and high dose groups.
Discussion
Corticosteroids have been postulated to facilitate post-operative ROM and reduce pain after TKA. However we were unable to show any significant clinical effect of peri-articular triamcinolone acetate at two different dosages. While it appears that corticosteroids are safe to administer in a select patient population, the results of this paper do not suggest a benefit in TKA.
