Combination Effect of High-Dose Preoperative and Periarticular Steroid Injection in Total Knee Arthroplasty. A Randomized Controlled Study

Should corticosteroids be administered for local infiltration analgesia in knee arthroplasty? A meta‐analysis and systematic review

“…Since the matched pair-randomized controlled trials were different from those that employed a standard parallel study design, the one-staged bilateral trials were assessed separately in subgroup analyses. 4,5,9 The pooled results of the VAS scores assessed at 24 h postoperatively revealed no differences in pain relief between the treatment and control groups (MD = −0.84; 95%CI: −1.74, 0.05; I 2 = 91%). Additionally, the same trials (including 290 knees) showed that corticosteroid infiltration resulted in a lower VAS score than the controlled group at 72 h postoperatively (MD = −0.84; 95%CI: −1.61, −0.07; I 2 = 85%).…”

“…One published meta-analysis has previously investigated the analgesic efficacy and functional recovery related to local infiltration of liposomal bupivacaine, 3 while some other studies have explored the degree of pain control associated with local infiltration of steroid compounds. 4,5 Glucocorticoids, which induce pronounced anti-inflammatory activity and immunomodulatory effects, reduce the local inflammatory response, including that caused by surgical trauma. 6 Hence, the addition of corticosteroids to LIA cocktails would seem to be a logical approach for providing pain relief after TKA.…”

“…Furthermore, the findings of six additional clinical trials have been published since the last systematic review was conducted by Deng et al 8 Of these six trials, three were matched pair-randomized controlled trials that investigated individual components of LIA cocktails; the design of these studies minimized the effect of potential confounding factors that were problematic in previous trials. 4,5,9 These factors imply the need for a renewed consideration of the summary effect measures related to the use of corticosteroids in LIA. Therefore, the aim of the present analysis was to critically evaluate the analgesic efficacy of corticosteroids in LIA based on a systematic review and meta-analysis of the recent literature.…”

“…It is inappropriate to include cross-over staged bilateral TKAs for comparison with unilateral TKAs; therefore, we excluded one trial from the pooled estimate. 28 Three matched pair-randomized controlled trials involving one-stage bilateral TKAs 4,5,9 were separately assessed in subgroup analyses, as they differed from the standard parallel group design of the other studies.…”

“…Among the fourteen trials, seven investigated the use of triamcinolone acetonide, 4,5,17,25,26,28,31 four explored the use of methylprednisolone, 9,16,24,29 two evaluated the administration of betamethasone, 15,30 and one assessed dexamethasone use. 27 The follow-up period ranged from the postoperative hospitalization period to 2 years after surgery.…”