Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan.
Department of Rehabilitation, Hokusuikai Kinen Hospital, Mito, Japan.
Bone Joint J. 2020 Oct;102-B(10):1297-1302. doi: 10.1302/0301-620X.102B10.BJJ-2020-0428.R1.
Although periarticular injection plays an important role in multimodal pain management following total hip arthroplasty (THA), there is no consensus on the optimal composition of the injection. In particular, it is not clear whether the addition of a corticosteroid improves the pain relief achieved nor whether it is associated with more complications than are observed without corticosteroid. The aim of this study was to quantify the safety and effectiveness of cortocosteroid use in periarticular injection during THA.
We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. A total of 187 patients were randomly assigned to receive periarticular injection containing either a corticosteroid (CS group) or without corticosteroid (no-CS group). Other perioperative interventions were identical for all patients. The primary outcome was postoperative pain at rest during the initial 24 hours after surgery. Pain score was recorded every three hours until 24 hours using a 100 mm visual analogue scale (VAS). The primary outcome was assessed based on the area under the curve (AUC).
The CS group had a significantly lower AUC postoperatively at 0 to 24 hours compared to the no-CS group (AUC of VAS score at rest 550 ± 362 vs 392 ± 320, respectively; mean difference 158 mm; 95% confidence interval (CI) 58 to 257; p = 0.0021). In point-by-point evaluation, the CS group had significantly lower VAS scores at 12, 15, 18, 21, 24, and 48 hours. There were no significant differences in complication rates, including surgical site infection, between the two groups.
The addition of corticosteroid to periarticular injections reduces postoperative pain without increasing complication rate following THA. Cite this article: 2020;102-B(10):1297-1302.
尽管关节周围注射在全髋关节置换术（THA）后多模式疼痛管理中发挥着重要作用，但对于注射的最佳成分尚未达成共识。特别是，皮质类固醇的添加是否能改善缓解疼痛尚不清楚，也不清楚它是否比不使用皮质类固醇时更常见并发症。本研究的目的是量化在 THA 中关节周围注射皮质类固醇的安全性和有效性。
我们进行了一项前瞻性、双臂、平行组、随机对照试验，涉及计划接受单侧 THA 的患者。共有 187 名患者被随机分配接受含有皮质类固醇（CS 组）或不含皮质类固醇（无 CS 组）的关节周围注射。所有患者的其他围手术期干预措施均相同。主要结局是术后 24 小时内静息时的初始术后疼痛。使用 100mm 视觉模拟量表（VAS）每 3 小时记录一次疼痛评分，直至 24 小时。主要结局基于曲线下面积（AUC）进行评估。
与无 CS 组相比，CS 组术后 0 至 24 小时 AUC 显著降低（静息时 VAS 评分 AUC 分别为 550±362 和 392±320，平均差异 158mm；95%置信区间（CI）为 58 至 257；p=0.0021）。在逐点评估中，CS 组在 12、15、18、21、24 和 48 小时的 VAS 评分显著降低。两组之间的并发症发生率，包括手术部位感染，均无显著差异。
在 THA 后，关节周围注射皮质类固醇可减轻术后疼痛，而不会增加并发症发生率。
文献来源：Bone Joint J. 2020;102-B(10):1297-1302.
