Effect of Steroid in Local Infiltration Analgesia in One-Stage Bilateral Total Knee Arthroplasty: A Paired-Randomized Controlled Study

Vincent Wai Kwan Chan; Ping Keung Chan; Chun Hoi Yan; Chun Him Henry; Chi Wing Chan; Kwong Yuen Chiu

doi:10.1055/s-0040-1713811

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2022; 35(03): 317-322
DOI: 10.1055/s-0040-1713811

Original Article

Effect of Steroid in Local Infiltration Analgesia in One-Stage Bilateral Total Knee Arthroplasty: A Paired-Randomized Controlled Study

Vincent Wai Kwan Chan

¹Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China

,

Ping Keung Chan

¹Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China

,

Chun Hoi Yan

¹Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China

,

Chun Him Henry

¹Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China

,

Chi Wing Chan

²Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China

,

Kwong Yuen Chiu

¹Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China

› Author Affiliations

Abstract

Although local infiltration analgesia (LIA) is effective in relieving pain after total knee arthroplasty (TKA), its effect is short lasting and the optimal combination of drugs is unknown. Steroids being a potent and long-acting anti-inflammatory drug might extend LIA's effect. This study aims to evaluate the role of steroids in LIA. This is a paired-randomized controlled study involving one-stage bilateral TKA patients. LIA containing ropivacaine, ketorolac, and adrenaline with or without triamcinolone was given. One knee was randomized to receive LIA with steroids, while the other received LIA without steroids. The primary outcome was knee pain in terms of the visual analog scale (VAS). Secondary outcomes were rehabilitation progress, functional scores, and complications. Outcomes were compared between the knees of the same patient and documented up to 1 year. A total of 45 patients (90 TKAs) were included. LIA with steroid knees showed lower VAS score at rest and during activity from postoperation day 1 to 5 and at 6 weeks (p < 0.05). Passive and active range of movement was also greater in LIA with steroid group from day 1 to 7 and day 2 to 5, respectively (p < 0.05). Steroid-treated knees also achieved active straight leg raise earlier (1.2 vs. 2.0 days, p < 0.05). No differences in Knee Society Score and complication rates between both groups. Steroids in LIA offer additional and extended benefit in pain control and rehabilitation after TKA, while no adverse effects were found up to 1-year follow-up.

Keywords

total knee arthroplasty - randomized controlled trial - local infiltration analgesia - steroid - fast-track arthroplasty

Full Text

References

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