For patients undergoing total knee arthroplasty (TKA), administration of intravenous (IV) plus periarticular corticosteroids did not improve pain control, but it did improve key indicators of functional recovery in the days after surgery, according to the results of a study published online ahead of print by The Journal of Bone & Joint Surgery.
In the study from Queen Mary Hospital in Hong Kong, the combination of IV plus periarticular corticosteroids “yielded more significant improvements in the rehabilitation parameters,” such as knee movement and walking distance.
“Thus, there was more robust evidence that corticosteroids enhanced functional recovery in the patients who received both [periarticular] and IV corticosteroids than in those who received intravenous corticosteroids only.”
Previous studies have reported effective pain relief and improved mobilization after TKA with either IV or periarticular corticosteroid administration. Would combining them allow for further improvement in pain and function?
To find out, the researchers randomly assigned 178 TKA patients to receive IV corticosteroids only, periarticular corticosteroids only, a combination of IV plus periarticular corticosteroids, or placebo injections. All patients received standard opioid medications for pain.
Pain relief and key rehabilitation parameters were compared across groups. Patients and the researchers evaluating outcomes were both blinded to the treatment the patients received.
In first few postoperative days, pain scores at rest and during movement were significantly lower for patients who received IV corticosteroids, with or without periarticular corticosteroids, as compared with the placebo group. Patients who received periarticular corticosteroids alone had no reduction in pain scores compared with the placebo group.
The combined use of IV plus periarticular corticosteroids led to improvement in several physical measures during rehabilitation. At 3 days after surgery, flexion in the operated knee was better for patients who received IV plus periarticular corticosteroids compared with the placebo group.
The IV plus periarticular corticosteroid group also had greater quadriceps muscle strength and longer walking distances during the first three postoperative days, as well as higher scores on an older adult mobility scale. Some parameters, but not all, were also improved for patients who received IV or periarticular corticosteroids alone, as compared with the placebo.
Patients who received IV plus periarticular corticosteroids were also more likely to be discharged home from the hospital, rather than to a rehabilitation facility (67% compared with 38% in the placebo group). Rates of discharge to home were 55% with IV corticosteroids alone and 59% with periarticular corticosteroids alone.
The study confirms the role of IV corticosteroids in pain management after TKA, with significant reductions in pain scores and morphine use compared with a placebo. Adding periarticular to IV corticosteroids does not improve postoperative pain control.
However, the combined use of IV plus periarticular corticosteroids provided greater functional recovery immediately postoperatively. “These improvements in rehabilitation and recovery parameters may have contributed to the higher percentage of patients who were discharged home,” the study authors said in their published paper.
“This study provides new insights into pain management in TKA that may enable better functional recovery and rehabilitation after TKA, and thereby advance the ability to perform arthroplasty as an outpatient procedure.”
Chan PK, Chan TCW, Mak CYH, et al. Pain relief after total knee arthroplasty with intravenous and periarticular corticosteroid: a randomized controlled trial. J Bone Joint Surg Am. 2023 May 23. doi: 10.2106/JBJS.22.01218. Online ahead of print.