Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis

Journal of Orthopaedic Surgery and Research

Liaobin Chen¹  Dongcai Hu¹  Rahul Mohanan¹  Yang Tan¹  Jun Qin¹  Xinyu Zhao¹ 

[1] Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan 430071, Hubei Province , China

关键词: Meta-analysis;    Periarticular injection;    Steroid;    Total knee arthroplasty;   

Others  :  1208599
DOI  :  10.1186/s13018-015-0214-8

 received in 2015-02-09, accepted in 2015-05-04,  发布年份 2015

【 摘 要 】

Background

Total knee arthroplasty (TKA) has been reported to be the most successful treatment for patients with advanced osteoarthritis, however, early postoperative pain has become an unresolved issue. The aim of this Meta-analysis is to evaluate the efficacy and safety of steroid addition to multimodal cocktail periarticular injection (MCPI) in patients undergoing TKA.

Method

Clinical randomized controlled trials concerning the efficacy and safety of MCPI containing steroids in TKA published up to December 2014 were retrieved from PubMed, Cochrane library, EMbase databases. The methodological quality of the included studies was assessed by the 12-item scale. Data analysis was performed using StataSE12.0.

Results

Six randomized controlled trials involving a total of 567 patients were assessed; the steroid group included 305 patients, and the control group included 262 patients. The meta-analysis showed that MCPI with steroids in TKA significantly reduced postoperative pain; duration of time required to perform straight-leg raising and length of hospital stay was (P < 0.05). Neither the early postoperative nor the long-term range of motion of knee showed any statistical difference between the non-steroid and steroid group (P >0.05). For safety, steroids did not increase the incidence of postoperative infection and wound oozing (P >0.05); no tendon rupture was reported up to now. In addition, steroids did not decrease the postoperative drainage through the reduction of prostaglandins (P >0.05).

Conclusion

For patients undergoing TKA, the addition of steroids to MCPI improved the analgesic effect and was proved to be highly safe. The duration of time required to perform straight-leg raising and length of hospital stay was significantly reduced. However, MCPI with steroids neither increased the early postoperative range of motion (ROM) or the long-term ROM of knee, nor did it reduce the postoperative drainage. However, the best results are acquired in patients without any altered immunological status.

【 授权许可】

   
2015 Zhao et al.; licensee BioMed Central.

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【 参考文献 】

• [1]Ng FY, Ng JK, Chiu KY et al.. Multimodal periarticular injection vs continuous femoral nerve block after total knee arthroplasty: a prospective, crossover, randomized clinical trial. J Arthroplasty. 2012; 27(6):1234-8.
• [2]Fu P, Wu Y, Wu H et al.. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty - a randomized controlled trial. Knee. 2009; 16(4):280-4.
• [3]Galimba J. Promoting the use of periarticular multimodal drug injection for total knee arthroplasty. Orthop Nurs. 2009; 28(5):250-6.
• [4]Fowler SJ, Symons J, Sabato S et al.. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008; 100(2):154-4.
• [5]Paul JE, Arya A, Hurlburt L et al.. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010; 113(5):1144-62.
• [6]Gibbs DM, Green TP, Esler CN. The local infiltration of analgesia following total knee replacement: a review of current literature. J Bone Joint Surg Br. 2012; 94(9):1154-9.
• [7]Creamer P. Intra-articular corticosteroid injections in osteoarthritis: do they work and if so, how? Ann Rheum Dis. 1997; 56(11):634-6.
• [8]Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2002; 195(5):694-712.
• [9]Pang HN, Lo NN, Yang KY et al.. Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up. J Bone Joint Surg Br. 2008; 90(6):738-44.
• [10]Christensen CP, Jacobs CA, Jennings HR. Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial. J Bone Joint Surg Am. 2009; 91(11):2550-5.
• [11]Ikeuchi M, Kamimoto Y, Izumi M et al.. Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2014; 22(7):1638-43.
• [12]Kwon SK, Yang IH, Bai SJ et al.. Periarticular injection with corticosteroid has an additional pain management effect in total knee arthroplasty. Yonsei Med J. 2014; 55(2):493-8.
• [13]Furlan AD, Pennick V, Bombardier C et al.. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine. 2009; 34(18):1929-41.
• [14]Yue DB, Wang BL, Liu KP et al.. Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty. Chin Med J (Engl). 2013; 126(20):3851-5.
• [15]Seah VW, Chin PL, Chia SL et al.. Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial. Singapore Med J. 2011; 52(1):19-23.
• [16]Chia SK, Wernecke GC, Harris IA et al.. Peri-articular steroid injection in total knee arthroplasty: a prospective, double blinded, randomized controlled trial.[J]. J Arthroplasty. 2013; 28(4):620-3.
• [17]Vendittoli PA, Makinen P, Drolet P et al.. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am. 2006; 88(2):282-9.
• [18]Busch CA, Shore BJ, Bhandari R et al.. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am. 2006; 88(5):959-63.
• [19]Ng YC, Lo NN, Yang KY et al.. Effects of periarticular steroid injection on knee function and the inflammatory response following unicondylar knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011; 19(1):60-5.
• [20]Salerno A, Hermann R. Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am. 2006; 88(6):1361-72.
• [21]Gilron I. Corticosteroids in postoperative pain management: future research directions for a multifaceted therapy. Acta Anaesthesiol Scand. 2004; 48(10):1221-2.
• [22]Wang JJ, Ho ST, Lee SC et al.. Intraarticular triamcinolone acetonide for pain control after arthroscopic knee surgery. Anesth Analg. 1998; 87(5):1113-6.
• [23]Sauerland S, Nagelschmidt M, Mallmann P et al.. Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review. Drug Saf. 2000; 23(5):449-61.
• [24]Wang Q, Jiang X, Tian W. Does previous intra-articular steroid injection increase the risk of joint infection following total hip arthroplasty or total knee arthroplasty? A meta-analysis. Med Sci Monit. 2014; 20:1878-83.
• [25]Marsland D, Mumith A, Barlow IW. Systematic review: the safety of intra-articular corticosteroid injection prior to total knee arthroplasty. Knee. 2014; 21(1):6-11.