Efficacy of additional corticosteroids to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis of randomized controlled trials

Qi Li, Guo Mu, Xiangbo Liu, Milian Chen, Qi Li, Guo Mu, Xiangbo Liu, Milian Chen

Abstract

Background: As the ultimate method for the treatment of osteoarthritis, total knee arthroplasty (TKA) has been widely used in the clinic. Local injection of multimodal cocktails, including corticosteroids, is commonly used for pain management after TKA. This meta-analysis aims to systematically evaluate the effect of periarticular injection of corticosteroids on postoperative pain relief and knee functional recovery in patients undergoing TKA.

Methods: PubMed, Cochrane Library, EMBASE, and Web of Science databases were comprehensively searched for all randomized controlled trials (RCTs) published before July 1, 2020, that investigated the efficacy of corticosteroids for TKA.

Results: Ten RCTs involving a total of 829 patients were assessed in the meta-analysis. Compared with the control group, the visual analogue scale (VAS) score at rest of the corticosteroid group decreased significantly at postoperative day 1 (POD1), POD2, and POD3 (p < 0.05). Besides, the range of flexion motion of the knee joint in the corticosteroid group at POD1 and POD2 was significantly increased (p < 0.05); at the same time, the range of extension motion at POD2 and POD3 showed the opposite trend between the two groups (p < 0.05). The morphine equivalent of postoperative analgesia was significantly reduced (p < 0.05), and the time required for straight leg raising (SLR) was significantly shortened (p < 0.05). There was no significant difference between the two groups in terms of postoperative drainage, length of hospital stay, and complications such as infection, nausea, and vomiting (p > 0.05).

Conclusion: The additional corticosteroids to multimodal cocktail periarticular injection can relieve the early pain intensity at rest after TKA, increase the early range of motion (ROM) of the knee joint, reduce the dosage of postoperative analgesics, and shorten the duration of time required for SLR. However, it has no effect on reducing postoperative complications and shortening the length of hospital stay.

Keywords: Corticosteroid; Periarticular injection; Total knee arthroplasty.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study selection
Fig. 2
Fig. 2
Forest plot showing VAS score at rest at POD1, POD2, POD3, POD4, POD5, POD7, and 2 weeks after the operation
Fig. 3
Fig. 3
Forest plot showing VAS score on motion at POD1, POD2, and POD3
Fig. 4
Fig. 4
Forest plot showing range of flexion motion at POD1, POD2, POD3, POD4, POD5, POD7, and 2, 4, 6, 12, and 24 weeks after the operation
Fig. 5
Fig. 5
Forest plot showing range of extension motion at POD1, POD2, POD3, POD4, and POD5
Fig. 6
Fig. 6
Forest plot showing morphine equivalent for postoperative analgesia
Fig. 7
Fig. 7
Forest plot showing postoperative drainage
Fig. 8
Fig. 8
Forest plot showing time for straight leg raising
Fig. 9
Fig. 9
Forest plot showing length of hospital stay
Fig. 10
Fig. 10
Forest plot showing incidence of complications
Fig. 11
Fig. 11
Risk of bias
Fig. 12
Fig. 12
Funnel plot

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