Osteonecrosis of the medial tibial plateau after intra-articular corticosteroid injection

Lee, Ju Hong; Wang, Sung Il; Noh, Sang Jae; Ham, Dong Hun; Kim, Ki Bum

doi:10.1097/md.0000000000017248

Cited by 10 publications

(3 citation statements)

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“…Although betamethasone suppresses inflammation, relieves pain, and contributes to healing and recovery, the local use of steroids may delay wound healing and lead to adverse events such as wound infection [ 33 , 34 ]. In our study, there were no wound complications in Group B.…”

Section: Discussionmentioning

confidence: 99%

Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Luo,

Zeng,

Chen

et al. 2024

International Journal of Clinical Practice

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Background. Local infiltration analgesia (LIA) provides postoperative analgesia for total knee arthroplasty (TKA). The purpose of this study was to evaluate the analgesic effect of a cocktail of ropivacaine, morphine, and Diprospan for TKA. Methods. A total of 100 patients from September 2018 to February 2019 were randomized into 2 groups. Group A (control group, 50 patients) received LIA of ropivacaine alone (80 ml, 0.25% ropivacaine). Group B (LIA group, 50 patients) received an LIA cocktail of ropivacaine, morphine, and Diprospan (80 ml, 0.25% ropivacaine, 0.125 mg/ml morphine, and 62.5 μg/ml compound betamethasone). The primary outcomes were the levels of inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6), pain visual analog scale (VAS) scores, opioid consumption, range of motion (ROM), functional tests, and sleeping quality. The secondary outcomes were adverse events, satisfaction rates, HSS scores, and SF-12 scores. The longest follow-up was 2 years. Results. The two groups showed no differences in terms of characteristics (P > 0.05). Group B had lower resting VAS pain scores (1.54 ± 0.60, 95% CI = 1.37 to 1.70 vs. 2.00 ± 0.63, 95% CI = 2.05 to 2.34) and active VAS pain scores (2.64 ± 0.62, 95% CI = 2.46 to 2.81 vs. 3.16 ± 0.75, 95% CI = 2.95 to 3.36) within 48 h postoperatively than Group A (P<0.001), while none of the pain differences exceeded the minimal clinically important difference (MCID). Group B had significantly lower CRP levels (59.49 ± 13.01, 95% CI = 55.88 to 63.09 vs. 65.95 ± 14.41, 95% CI = 61.95 to 69.94) and IL-6 levels (44.11 ± 13.67, 95% CI = 40.32 to 47.89 vs. 60.72 ± 15.49, 95% CI = 56.42 to 65.01), lower opioid consumption (7.60 ± 11.10, 95% CI = 4.52 to 10.67 vs. 13.80 ± 14.68, 95% CI = 9.73 to 17.86), better ROM (110.20 ± 10.46, 95% CI = 107.30 to 113.09 vs. 105.30 ± 10.02, 95% CI = 102.52 to 108.07), better sleep quality (3.40 ± 1.03, 95% CI = 3.11 to 3.68 vs. 4.20 ± 1.06, 95% CI = 3.90 to 4.49), and higher satisfaction rates than Group A within 48 h postoperatively (P < 0.05). Adverse events, HSS scores, and SF-12 scores were not significantly different within 2 years postoperatively. Conclusions. A cocktail of ropivacaine, morphine, and Diprospan prolongs the analgesic effect up to 48 h postoperatively. Although the small statistical benefit may not result in MCID, the LIA cocktail still reduces opioid consumption, results in better sleeping quality and faster rehabilitation, and does not increase adverse events. Therefore, cocktails of ropivacaine, morphine, and Diprospan have good application value for pain control in TKA. This trial is registered with ChiCTR1800018372.

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Section: Discussionmentioning

confidence: 99%

Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Luo,

Zeng,

Chen

et al. 2024

International Journal of Clinical Practice

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“…The anti-in ammatory effects of glucocorticoids include varying degrees of disruption of prostaglandin and cyclooxygenase pathways [32][33][34] . Glucocorticoids act directly on nuclear steroid receptors, and control the rate of mRNA/protein synthesis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Periarticular Injections of Triamcinolone Acetonide During Unicompartmental Knee Arthroplasty in the Perioperative Period: A Randomized Clinical Trial

Gao

Zhai

Yue

et al. 2020

Preprint

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Abstract Background: Unicompartmental knee arthroplasty (UKA) is a minimally invasive procedure that preserves most knee tissue, but can also cause moderate-to-severe pain. We investigated if triamcinolone acetonide (TA) addition to a “cocktail” of agents in a periarticular injection could reduce postoperative pain and the inflammatory response, and promote rapid recovery after UKA.Methods: This was a prospective randomized clinical trial undertaken from March 2018 to October 2019. Patients were divided randomly into a control group (A) and TA group (B). In group A, a 50-mL cocktail lacking TA was injected in tissue around the joint cavity. In group B, a 50-mL cocktail containing TA was injected. Primary-outcome measurements were the visual analog pain score upon rest (VASR) and exercise (VASE), morphine consumption, range of motion (RoM), level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in venous blood at different times. Complications were also monitored.Results: Forty-five patients in group A and 46 patients in group B were assessed. At 6, 12 and 24 h postoperatively, VASR in group A was significantly higher than that in group B (P<0.05). At 6 and 12 h postoperatively, VASE in group A was significantly higher than that in group B (P<0.05). Morphine consumption in group A was significantly higher than that in group B at 0–24 h (P<0.05) and 0–48 h (P<0.05) after surgery. At postoperative day (POD)1–3, the RoM in group B was significantly higher than that in group A (P<0.05). There was a significant decrease in CRP level in group B vs. group A on POD1 (P<0.05) and POD3 (P<0.05). The ESR of group B was significantly lower than that of group B on POD3 (P<0.05) and POD5 (P<0.05). No serious complications occurred in either group.Conclusion: TA addition to a cocktail of agents for periarticular injection effectively relieved pain, improved knee-joint function, reduced the inflammatory response, did not increase risk of complications, and promoted rapid recovery after UKA.

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“… 22. Yousef et al20 reported a case of bilateral knee osteonecrosis following long-term intra-nasal steroid therapy.…”

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confidence: 99%

Osteonecrosis of the Knee: The Unintended Consequence of Steroid Abuse

Sondur,

VJ,

Das

2024

Clin Med Res

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The anti-inflammatory and immunosuppressive properties of steroids allow their use in a wide variety of rheumatological diseases, asthma, inflammatory bowel disease, cancer therapy, and severe viral infections. Though life-saving or organ-saving, long-term clinical use leads to a vast array of complications. Osteoporosis is the most common orthopedic side effect of steroid abuse, while osteonecrosis is a rare occurrence. The risk of osteonecrosis appears to be dose and duration dependent, but several patient factors also play a major role and usually affect the femoral head followed by the knee joint. The long-term effects of steroids must be explained to all patients on therapy, but this risk is missed in individuals who abuse steroids for recreational or performanceenhancing purposes. We describe a male, aged 29 years, who presented with dull aching bilateral knee pain of 2-years' duration after a long-term steroid abuse for weight and muscle mass gain. Radiological and magnetic resonance imaging studies confirmed osteonecrosis of femoral and tibial condyles and secondary degenerative arthritis of the knee joint. Prompt suspicion, early diagnosis, and intervention in osteonecrosis of knee joints, and termination of steroids may reverse the pathology and prevent progression of disease.

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Osteonecrosis of the medial tibial plateau after intra-articular corticosteroid injection

Cited by 10 publications

References 9 publications

Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Cocktail of Ropivacaine, Morphine, and Diprospan Reduces Pain and Prolongs Analgesic Effects after Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Effect of Periarticular Injections of Triamcinolone Acetonide During Unicompartmental Knee Arthroplasty in the Perioperative Period: A Randomized Clinical Trial

Osteonecrosis of the Knee: The Unintended Consequence of Steroid Abuse

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