Summary. Corticosteroids (CS) are commonly administered by intra-articular injection to control the symptoms of osteoarthritis; however, CSs also suppress articular chondrocyte matrix synthesis. Both triamcinolone and methylprednisolone acetate significantly suppressed BMPs −2 and −7, and TGF-b1 expression, suggesting a mechanism by which CSs suppress articular chondrocyte matrix synthesis and cartilage homeostasis. Introduction. Osteoarthritis (OA) is a common and debilitating disease that affects approximately 30% of the US population and is also a major clinical problem in companion animals. There are many drugs available to manage the symptoms of OA. Of these, intra-articular corticosteroid (CS) administration is a common and very effective anti-arthritic therapy, and is frequently administered to equine athletes. CSs exert their potent anti-inflammatory effects by blocking phospholipase A and reducing inflammatory mediator production; however, CSs also suppress matrix-biosynthetic activity of articular chondrocytes. This activity, along with ther increased joint use that symptomatic relief allows, has been linked to ‘steroid arthropathy’; a progression of arthritis driven by compromised chondrocyte homeostatic capacity. Several lines of experimental and clinical evidence emphasise the importance of TGF-b and BMP autocrine/paracrine activity in maintaining the homeostatic status of articular chondrocytes (reviewed in Oshin and Stewart 2007). This study was carried out to address the following objectives: 1) To assess the effects of CS on expression of chondro-protective TGF-β and BMP ligands in equine articular chondrocytes, and 2) To determine if exogenous BMP ligand administration can mitigate the suppressive effects of CSs on articular chondrocyte synthesis of collagen type II (Coll II) and glycosaminoglycans (sGAG). Methods. Articular cartilage was collected from clinically normal joints of adult horses, euthanased for reasons other than musculoskeletal disease. Articular chondrocytes were isolated by collagenase digestion and cultured as aggregates in serum-free medium under non-adherent conditions (Stewart et al 2000). Triamcinolone acetate (TA) or methylprednisolone acetate (MPA) was added to the articular chondrocyte cultures at 10. −10. M, 10. −7. M, and 10. −5. M; comparable to in vivo exposure concentrations. Effects on Coll II, aggrecan/sGAG, BMP and TGF-b ligand expression were assessed by QPCR, Coll II ELISAs and DMMB assays. In a separate series of experiments, exogenous BMP-2 was administered to chondrocyte cultures exposed to CS supplementation, to determine whether BMP can prevent or mitigate CS-mediated suppression of matrix synthesis. Results. BMP-2 and BMP-7 mRNA levels were significantly down-regulated by both CS treatments. In contrast, expression of BMPs-4 and 6 was not affected at any of the CS doses tested. TGF-b1 mRNA levels were significantly suppressed by both CSs at all doses tested. Somewhat surprisingly, TGF-b2 expression was increased by CS administration, though not significantly, while TGF-b3 expression was not affected. Exogenous BMP-2 administration (1–100 ng/ml) increased Coll II expression in the control groups but did not prevent the suppression of Coll II or sGAG synthesis in CS-treated chondrocytes. Discussion/Conclusions. Both TA and MPA down-regulated BMP-2, BMP-7 and TGF-b1 mRNA expression in articular chondrocytes. These CS-mediated effects appear to be gene-specific, since BMPs-4 and 6, and TGF-bs 2 and 3 were not similarly affected. Although exogenous BMP-2 administration increased Coll II production under control conditions, this did not effectively prevent CS-mediated suppressive effects on cartilage matrix synthesis. This suggests that other elements of the articular chondrocyte BMP and/or TGF-b signaling pathways are also affected by CS administration

Objectives. The main objective of our study was to determine the treatment effect of corticosteroids in peri-radicular infiltration for radicular pain. We also examined whether there was any effect on the need for subsequent interventions such as additional root blocks and/or surgery. Subjects and Method. In a randomised, double blind controlled trial, 150 eligible patients with radicular pain and unilateral symptoms who failed conservative management were randomised for a single injection with bupivacaine and methylprednisolone (b+s) or bupivacaine (b) alone. The outcome measures used included the Oswestry Disability Index (ODI), Low Back Outcome Score (LBOS), Visual Analogue Score (VAS) for leg pain and back pain and patient's subjective level of satisfaction of the outcome. Results. We recruited 76 patients in the b only group and 74 patients in the b+s group. There was no statistically significant difference in the outcome measures between the groups at 3 months (change in ODI [p=0.2], change in VAS [back pain, p=0.28; leg pain, p=0.67]. Subgroup analysis revealed that there was no statistically significant difference in the change in scores between the stenotic group and disc herniation group at 3 months. At 1 year follow-up data was available for 86% of the patients. There was no statistically significant difference in the rate of further interventions in either group. Conclusion. Clinical improvement occurs in both groups of patients. Corticosteroids did not provide additional benefit. There is no difference in the need for further root blocks or surgery

Objectives: To determine the treatment effect of corticosteroids in peri-radicular infiltration for radicular pain. Secondary investigations were on the requirement for subsequent interventions such as root blocks and/or surgery. A sub group analysis between sciatica and stenosis was undertaken. Study Design: A randomised, double blind controlled trial. Subjects: 150 eligible patients with radicular pain and unilateral chronic symptoms were randomised for a single injection with bupivacaine and methylprednisolone (b+s) or bupivacaine (b) alone. Outcome measures: The outcome measures included the Oswestry Disability Index (ODI), Low Back Outcome Score (LBOS), Visual Analogue Score (VAS) for leg pain and back pain and patient’s subjective level of satisfaction of the outcome. Results: 76 patients in the b only group and 74 patients in the b+s group. Clinically useful improvements of greater than 10 points on the ODI occurred in 54%, deterioration of 10 points or more occurred in 17%. Visual analogue for leg improved by 2 or more in 63%. There was no statistically significant difference between the groups at 3 months (change in ODI [p=0.2], change in VAS [back pain, p=0.28; leg pain, p=0.67]. Subgroup analysis revealed no statistically significant difference in the change in scores between the stenotic group and disc herniation group at 3 months. At 1 year follow-up data was available for 86% of the patients. There was no statistically significant difference in the rate of further interventions. Conclusion: Clinical improvement occurs in both groups of patients. Corticosteroids did not provide additional benefit. There is no difference in the need for further root blocks or surgery

Local infiltration analgesia (LIA) is promoted as an effective treatment modality for pain control after total knee arthroplasty (TKA) (1). A mixture of drugs is used to provide a multimodal analgesic effect. Previous studies reported that the use of these drugs is safe. After we carefully implemented a LIA study protocol in our practice, concerns raised about patient safety with probably higher infection rates. This forced us to perform an interim analysis after the first 58 cases.

58 patients underwent a unilateral TKA with a standardised LIA protocol (2), which consisted of a mixture of ropivacaine, epinephrine, and triamcinolone acetonide. Complications, knee function and patient satisfaction scores were prospectively recorded during regular outpatient control.

Four patients (6.9%) presented with signs of periprosthetic joint infection (PJI) within two months after surgery. Baseline characteristics were similar between the infected and non infected group. All infections were treated with debridement and retention, and antimicrobial treatment was started. One patient who suffered an infection died during followup. At two years followup all implants could be retained. Knee function and KSS score were acceptable for the patients who suffered PJI.

There is no consensus on the combination of drugs used for LIA. The application of corticosteroids in LIA is reported to be safe (3), but arguable results about the injection of local corticosteroids around knee arthroplasty surgery in the past have raised suspicion in literature (4). Combined with our unacceptable high rate of PJI, we believe that the current body of evidence, with small heterogeneous series, does not support the safe use of corticosteroids in LIA.

1. Because of the controversy over the clinical effects of corticosteroids on joint tissues a series of experiments on the knee joints of rabbits was undertaken.

2. The articular cartilage of the distal femoral epiphyses of normalcontrols has been compared with that of rabbits treated daily either with cortisone or with methyl prednisolone systemically or by intra-articular injections.

3. The changes caused by intravenous papain and their subsequent recovery have been described, and the adverse effect of corticosteroids on recovery has been assessed.

4. The biological mechanisms involved are discussed, and as a result caution is urged in the administration of corticosteroids in the presence of progressive degenerative joint disease.

Aims

A local injection may be used as an early option in the treatment of Morton’s neuroma, and can be performed using various medications. The aim of this study was to compare the effects of injections of hyaluronic acid compared with corticosteroid in the treatment of this condition.

Children undergoing continuous corticosteroid therapy become stunted in height. The mechanism of this inhibition of natural growth has been investigated in the lower femoral epiphysial growth plate of young rabbits on daily corticosteroid. The growth plate became narrow: fewer cells in the germinative zone gave rise to short widely-spaced chondrocyte columns, each with a reduced number of mature and hypertrophic cells; the pattern of trabecular bone in the metaphysis was also disturbed. After even small doses these changes develop very rapidly, and therefore impose a threat to the growth of children receiving treatment with corticosteroids.

Background: Nerve Root pain is a problem caused by mechanical compression from disc herniation or foraminal stenosis, which stimulates an inflammatory response. We present a review of the evidence for corticosteroid infiltration in nerve root infiltration (NRI).

Methods: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised controlled trials of the use of NRI in the treatment of radicular pain. For the purpose of this meta-analysis, the control group “no steroid” was chosen to encompass various subtypes. The primary outcomes were Oswestry Disability Scores (ODI) and Visual Analogue Scores (VAS) for pain. Outcomes were compared at 3 and 6 months from injection. For the purpose of the meta-analysis, repeat injection and progression to surgery are grouped as a composite endpoint.

Results: We identified 96 papers; but only 5 RCT’s which included 402 patients receiving NRI; 202 were randomised to receiving steroids. No trials reported significant intergroup differences in baseline VAS or ODI.

At 3 months there was no significant difference in VAS or ODI between the groups. Only two trials reported ODI data at 6 months but a significant effect in favour of the control arm was noted (P = 0.040). Four of the five trials reported the need for further injection or surgery due to failure but no significant difference between the groups was found (P = 0.038).

Conclusion: Our analysis suggests that the addition of steroids to local anaesthetic agents or placebo solutions confers no additional benefit, but the theoretical risk of infection. Further information is needed on hospital stay, economic and long term responses, and is required to counter confounding with small trials and study numbers, and any methodological heterogeneity.

The efficacy of intra-articular corticosteroids has led to their frequent use in the treatment of osteoarthritis (OA) of the knee. It is commonly believed that less soluble preparations given at higher doses provide longer lasting and more significant symptomatic relief. We performed a randomized controlled trial with corticosteroid preparations of different solubilities and dosages to test this longstanding but unproven belief. The pain subscale of the WOMAC was our primary outcome measurement. This study found no statistically significant difference between preparations or dosages. Regression analysis identified early onset of osteoarthritis as predictive of a positive treatment response.

To determine if the solubility or dosage of an intra-articular corticosteroid preparation effects treatment outcome when used for the treatment of symptomatic osteoarthritis of the knee.

One hundred and seventeen patients, thirty-nine in each treatment arm, were enrolled in the study. Patients were randomly assigned to one of three treatment arms: 40mg of methylprednisolone acetate, 80mg of methyl-prednisolone acetate or 40mg Triamcinolone acetanide. Patients were unaware of the preparation given. The IA injection was given at the commencement of the study period. Patients underwent clinical evaluation at baseline and at two weeks, four weeks and twelve weeks post injection. Patient’s symptoms were evaluated using the Western Ontario and McMaster Universities OA Index (WOMAC). Patient age, sex, age of onset of OA, history of trauma to the knee and BMI were also recorded and used to identify patient variables predictive of a positive treatment response.

No statistically significant difference between the three treatment arms was identified. Early onset of OA was identified as predictive of a positive treatment response.

It has been taught that physicians should use the least soluble preparation at higher doses (within suggested guidelines) to maximize patient treatment response when using intra-articular corticosteroids. This has always been based on theory and not fact. Our study is the first to scientifically disprove this claim. Solubility and dosage do not effect treatment outcomes. Patients with an early onset of OA seem to have a positive treatment response.

Ours is the first study to demonstrate these findings.

Fat embolism syndrome (FES) is a potentially lethal condition commonly seen in poly-traumatised patients, particularly those with multiple long-bone fractures. Treatment has centered around supportive care and early fracture fixation. Several clinical small trials have suggested corticosteroids benefit patients with FES but its use remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with multiple long-bone fractures.

We conducted a meta-analysis of randomised trials, searching computerised databases for published studies from 1966–2006. Additionally, we performed hand searches of major orthopaedic journals, meeting proceedings, and texts. Our primary outcome was the rate of FES. Secondary outcomes included presence of hypoxia, petechiae, mortality, infection, and delayed union.

Of the one hundred and four studies identified, nine were potentially eligible, and only seven met all our eligibility criteria. From our pooled analysis of three hundred and eighty-nine patients, we found that corticosteroids reduced the risk of FES by 78% (95%CI: 43–92%, heterogeneity p-value=0.62, I2=10%) and that only eight patients needed to be treated (NNT=7.5) to prevent one case of FES (95%CI: five to thirteen patients). We did not find any significant differences in the rates of mortality, infection, or delayed union.

The current evidence suggests that the use of corticosteroids is beneficial in the prevention of fat embolism syndrome in patients with multiple long-bone fractures. The use of corticosteroids does not appear to significantly increase the risk of complications although a confirmatory large randomised trial is needed.

Study Design: A randomized, double blind controlled trial.

Objectives: Various studies have examined the therapeutic value of peri-radicular infiltration using treatment agents consisting of local anaesthetic and corticosteroids for radicular pain. The main objective is to determine the treatment effect of corticosteroids in peri-radicular infiltration for radicular pain. We also examined prognostic factors in relation to the outcome of the procedure.

Subjects: Eligible patients with radicular pain who had unilateral symptoms who failed conservative management were randomised for a single injection with bupivicaine and methylprednisolone (b+s) or bupivicaine (b) only.

Outcome measures: Oswestry Disability Index (ODI), Visual Analogue Score (VAS) for back pain and leg pain, claudication walking distance and patient’s subjective level of satisfaction of the outcome.

Results: We recruited 43 patients in the b+s group and 43 patients in the b only group. The follow up rate is 100%. There is no statistically significant difference in the outcome measures between the groups at 3 months (change of the ODI [p=0.7], change in VAS [back pain, p=0.68; leg pain, p=0.94], change in walking distance [p=0.7]). No statistical difference in the change in VAS score between stenotic group and disc herniation group at 3 months. Further subgroup analysis also showed no difference in the outcome between contained and non-contained herniation group.

Conclusion: Clinical improvement occurs in both groups of patients. Corticosteroid did not provide additional benefit.

Introduction: Despite the present routine treatment of septic arthritis with antibacterial agents, articular damage is persistent and frequently leads to loss of joint function. The aim of this study was to assess the effect of intra-articular corticosteroid added to systemic antibiotics in the treatment of experimental staphylococcal knee joint infection in rabbits.

Material and Methods: Thirty rabbits were injected in their knees by staphylococcus aureus. The rabbits were divided into 3 equal groups. In group A, rabbits received no treatment. In group B, rabbits were treated with systemic antibiotics alone. Group C, received systemic antibiotics and intra-articular corticosteroid. After 16 days animals were killed and the knee joint X-Ray as well as histopathological-histochemical parameters were assessed.

Results: All rabbits survived the experiment; the treated groups (B, C) had better histopathological-histochemical scores in comparison with the untreated group (A). Group C had significantly better scores in joint sections in comparison with group B (mean SD=6.7 ± 2.3 v 4.0 ± 2.4, P= 0.019). Lower damage in the former group was expressed in lesser clustering of chondrocytes, proteoglycan depletion, and severity of synovitis. Radiological soft tissue scoring was significantly better in group C in comparison with group B. Three peri-articular abcesses were observed in group C but none in group B.

Conclusion: Addition of intra-articularly administered corticosteroid to antibiotic treatment of septic arthritis improved histopathological-histochemical parameters in this experimental setting, although on account of the clinical observation of three cases with peri-articular abcesses in this group, caution is warranted in the interpretation of these results.

Study Design: A randomised, double-blind controlled trial.

Objectives: To determine the efficacy of corticosteroids in periradicular infiltration for radicular pain. We also examined prognostic factors in relation to the outcome of the procedure.

Summary of background data: Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anaesthetic and corticosteroids for radicular pain, secondary to lumbar disc herniation and spinal stenosis. There is currently no randomised trial to determine the efficacy of single injection of corticosteroids.

Methods: Eligible patients with radicular pain who had unilateral symptoms who failed conservative management were randomised for single double-blind injection with bupivicaine and methylprednisolone (b+s) or bupivicaine (b) only. Outcome measures include change in Oswestry Disability Index (ODI), change in Visual Analogue Score for back pain and leg pain (VAS), change in walking distance and patient’s subjective level of satisfaction of the outcome. Objective successful clinical outcome is defined as a change in 10% of ODI.

Results: We recruited 37 patients in the b+s group and 38 patients in the b only group. The follow up rate is 100%. 4 patients had early termination of the trial for discectomy and further rootblock. There is no statistically significant difference in the outcome measure between the groups at 3 months (change of the ODI [p=0.6], change in VAS [back pain, p=0.28, leg pain, p=0.95], change in walking distance [p=0.9]). 35% of patients in the b+s group and 55% in the b only group had a successful clinical outcome. Duration of symptoms has a statistically significant negative association with the change in ODI (p=0.03). No prognostic value is found in age, gender, pre-operative Modified Somatic Perception and Modified Zung Depression score.

Conclusion: Clinical improvement occurs in both groups of patients. However, corticosteroids do not provide additional benefit.

A total of 159 patients (84 women and 75 men, mean age of 53 (20 to 87)) with subacromial impingement were randomised to treatment with subacromial injections using lidocaine with one of hyaluronic acid (51 patients), corticosteroid (53 patients) or placebo (55 patients). Patients were followed up for 26 weeks. The primary outcome was pain on a visual analogue score (VAS), and secondary outcomes included the Constant Murley score, shoulder pain score, functional mobility score, shoulder disability questionnaire and pain-specific disability score. The different outcome measures showed similar results. After three, six and 12 weeks corticosteroid injections were superior to hyaluronic acid injections and only at six weeks significantly better than placebo injections. The mean short-term reduction in pain on the VAS score at 12 weeks was 7% (sd 2.7; 97.5% confidence interval (CI) 0.207 to 1.55; p = 0.084) in the hyaluronic acid group, 28% (sd 2.8; 97.5% CI 1.86 to 3.65; p < 0.001) in the corticosteroid group and 23% (sd 3.23; 97.5% CI 1.25 to 3.26; p < 0.001) in the placebo group. At 26 weeks there was a reduction in pain in 63% (32 of 51) of patients in the hyaluronic acid group, 72% (38 of 53) of those in the corticosteroid group and 69% (38 of 55) of those in the placebo group.

We were not able to show a convincing benefit from hyaluronic acid injections compared with corticosteroid or placebo injections. Corticosteroid injections produced a significant reduction in pain in the short term (three to 12 weeks), but in the long term the placebo injection produced the best results.

Peri-tendinous injection of local anaesthetic, both alone and in combination with corticosteroids, is commonly performed in the treatment of tendinopathies. Previous studies have shown that local anaesthetics and corticosteroids are chondrotoxic, but their effect on tenocytes remains unknown. We compared the effects of lidocaine and ropivacaine, alone or combined with dexamethasone, on the viability of cultured bovine tenocytes. Tenocytes were exposed to ten different conditions: 1) normal saline; 2) 1% lidocaine; 3) 2% lidocaine; 4) 0.2% ropivacaine; 5) 0.5% ropivacaine; 6) dexamethasone (dex); 7) 1% lidocaine+dex; 8) 2% lidocaine+dex; 9) 0.2% ropivacaine+dex; and 10) 0.5% ropivacaine+dex, for 30 minutes. After a 24-hour recovery period, the viability of the tenocytes was quantified using the CellTiter-Glo viability assay and fluorescence-activated cell sorting (FACS) for live/dead cell counts. A 30-minute exposure to lidocaine alone was significantly toxic to the tenocytes in a dose-dependent manner, but a 30-minute exposure to ropivacaine or dexamethasone alone was not significantly toxic.

Dexamethasone potentiated ropivacaine tenocyte toxicity at higher doses of ropivacaine, but did not potentiate lidocaine tenocyte toxicity. As seen in other cell types, lidocaine has a dose-dependent toxicity to tenocytes but ropivacaine is not significantly toxic. Although dexamethasone alone is not toxic, its combination with 0.5% ropivacaine significantly increased its toxicity to tenocytes. These findings might be relevant to clinical practice and warrant further investigation.

Corticosteroids are prescribed for the treatment of many medical conditions and their adverse effects on bone, including steroid-associated osteoporosis and osteonecrosis, are well documented. Core decompression is performed to treat osteonecrosis, but the results are variable. As steroids may affect bone turnover, this study was designed to investigate bone healing within a bone tunnel after core decompression in an experimental model of steroid-associated osteonecrosis. A total of five 28-week-old New Zealand rabbits were used to establish a model of steroid-induced osteonecrosis and another five rabbits served as controls. Two weeks after the induction of osteonecrosis, core decompression was performed by creating a bone tunnel 3 mm in diameter in both distal femora of each rabbit in both the experimental osteonecrosis and control groups. An in vivo micro-CT scanner was used to monitor healing within the bone tunnel at four, eight and 12 weeks postoperatively. At week 12, the animals were killed for histological and biomechanical analysis. In the osteonecrosis group all measurements of bone healing and maturation were lower compared with the control group. Impaired osteogenesis and remodelling within the bone tunnel was demonstrated in the steroid-induced osteonecrosis, accompanied by inferior mechanical properties of the bone. We have confirmed impaired bone healing in a model of bone defects in rabbits with pulsed administration of corticosteroids. This finding may be important in the development of strategies for treatment to improve the prognosis of fracture healing or the repair of bone defects in patients receiving steroid treatment

Introduction. Intra-articular (IA) injections of corticosteroids and hyaluronic acid (HA) products are used to treat patients with knee osteoarthritis pain that has not responded to more conservative treatment. Corticosteroids are a standard of care despite only suggestive clinical evidence of 12 or more weeks of pain relief. However the duration of pain relief with this treatment appears to be short and not a long term solution. Methods. A double-blinded, randomised, active controlled, multicentre non-inferiority trial with 442 subjects provided a pragmatic comparison of HA to methylprednisolone. These patients were collected prospectively and with excellent long term follow-up. Results. The HA responder rates were good at 12 weeks and better at the later time points (6 to 9 months) while the methylprednisolone rate decreased significantly by 26 weeks. Conclusion. HA appears to be a reasonable mid to long term solution for patients with Kellgren grade 1 and 2 arthritis. It lasts longer than steroids and has what appears to be a cost-effective advantage

Purpose: Intra-articular (IA) injections of corticosteroids and hyaluronic acid (HA) products are used to treat patients with knee osteoarthritis pain that has not responded to more conservative treatment. Corticosteroids are a standard of care despite only suggestive clinical evidence of 12 or more weeks of pain relief. Method: A double-blinded, randomized, active controlled, multicenter non-inferiority trial with 442 subjects provided a pragmatic comparison of HA to methylprednisolone. Both groups received one intrar-ticular injection, and underwent pain and function evaluations over 26 weeks. The primary endpoint for study success was WOMAC pain responder rate at 12 weeks. The outcome of two prior trials influenced the patient selection criteria and provided a saline cohort for propensity score analyses comparing HA and methylprednisolone to saline. Results: The responder rate of HA was non-inferior to methylprednisolone at 12 weeks. Reductions in WOMAC pain, stiffness and physical function scores at all time points, and improvements in time to ‘get-up-and-go’ and walk 10 meters occurred in both treatment groups. The trends favored the HA responder rates at the later time points while the methylprednisolone rate decreased significantly by 26 weeks. Propensity score analyses confirmed that the responder rates of meth-ylprednisolone and HA were statistically significantly superior to a saline control at 12 weeks. Conclusion: The responder rate from a single injection of HA was non-inferior to methylprednisolone at 12 weeks, and the trend favored HA at later time points. The responder rates of HA and methylprednisolone were statistically significantly greater than that of saline at 12 weeks

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

Drug Free Sport New Zealand (DFSNZ) aims to maintain New Zealand Sport as a drug free environment and thereby enhance our proud and successful sporting culture. New Zealand is bound into the World Anti-Doping Code and must therefore adhere to World Anti-Doping rules. Detection of doping violations is one of the functions of DFSNZ. An aim of DFSNZ is to eliminate the risk of athletes failing a sports anti-doping test as a result of using legitimately prescribed medication as treatment without a Therapeutic Use Exemption (TUE). This can create major problems for the athlete who may then have to appear before the Sports Tribunal. Some substances on the prohibited list are used by Orthopaedic Surgeons as part of regular management. “National level” athletes require a TUE to be completed prior to use of these medications or immediately following use in emergency situations. Examples are:. Narcotics and Intravenous Corticosteroids perioperatively. Probenecid to enhance antibiotic concentrations in treating infections. Other athletes who are not in this category but may be tested do not require a TUE immediately but still have to be able to provide evidence that the medication was used for therapeutic use if they were subsequently to fail a test. It is the athlete’s responsibility to notify the surgeon and obtain the appropriate documentation. Athletes in the Testing Pools will carry a card with reference to MIMS Resources, the DFSNZ website and Hot-line. From time to time athletes stressed by the situation of their injury may forget to notify the surgeon, prior to surgery, of anti-doping requirements. Surgeon (and anaesthetist) awareness and support for the programme will enhance the overall care of the patient and limit subsequent demands on both the patient and medical staff. The aim of this presentation is to enlighten NZOA members regarding the correct procedures to follow should a prohibited substance be required when treating an athlete who is subject to drug testing in sport