A study has found that a combination of intravenous and periarticular corticosteroids may improve functional recovery in the days after total knee arthroplasty (TKA), despite not enhancing pain control. The research, published in The Journal of Bone and Joint Surgery, found that corticosteroids improved functional recovery and rehabilitation parameters such as knee movement and walking distance in patients who received both PA and IV corticosteroids than in those who received IV corticosteroids only. Patients who received IV plus PA corticosteroids were more likely to be discharged home from the hospital, rather than to a rehabilitation facility.
The study found that pain scores at rest and during movement were significantly lower for patients who received IV corticosteroids, with or without PA corticosteroids as compared with the placebo group. Patients who received PA corticosteroids alone had no reduction in pain scores compared with the placebo. The combined use of IV plus PA corticosteroids led to improvement in several physical measures during rehabilitation. At three days, flexion in the operated knee was better for patients who received IV plus PA corticosteroids compared with the placebo. The IV plus PA 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 elderly mobility scale.
Lead author, TCW Chan MBBS, and his colleagues say “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.”
The study also 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 PA to IV corticosteroids does not improve postoperative pain control.
TKA is a widely performed and cost-effective procedure, but many patients experience substantial postoperative pain. Previous studies have reported effective pain relief and improved mobilisation after TKA with either IV or PA corticosteroid administration.
The researchers evaluated pain relief and key rehabilitation parameters across four groups of patients, each undergoing initial TKA. 178 patients in total were randomly assigned to receive IV, PA, or IV plus PA corticosteroids, or placebo injections. All patients received standard opioid medications for pain.
Patients and the researchers evaluating outcomes were both blinded to the treatment the patients received.
