Department of Anesthesiology, Shehong People's Hospital, NO.19, Guanghan road, Shehong, 629200, Sichuan Province, People's Republic of China.
Southwest Medical University, NO.319, Section 3, Zhongshan road, Jiangyang District, Luzhou, 646000, Sichuan Province, People's Republic of China.
J Orthop Surg Res. 2021 Jan 22;16(1):77. doi: 10.1186/s13018-020-02144-0.
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.
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.
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).
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.
全膝关节置换术（TKA）作为治疗骨关节炎的终极方法，已在临床上广泛应用。局部注射包括皮质类固醇在内的多模式鸡尾酒常用于 TKA 后的疼痛管理。本荟萃分析旨在系统评估关节周围注射皮质类固醇对 TKA 术后疼痛缓解和膝关节功能恢复的影响。
全面检索 PubMed、Cochrane Library、EMBASE 和 Web of Science 数据库，以获取截至 2020 年 7 月 1 日发表的所有评估皮质类固醇用于 TKA 疗效的随机对照试验（RCT）。
10 项 RCT 共纳入 829 例患者，纳入荟萃分析。与对照组相比，皮质类固醇组在术后第 1 天（POD1）、第 2 天（POD2）和第 3 天（POD3）的静息时视觉模拟评分（VAS）显著降低（p<0.05）。此外，皮质类固醇组在 POD1 和 POD2 时膝关节的屈曲运动范围显著增加（p<0.05）；同时，两组在 POD2 和 POD3 时的伸展运动范围呈相反趋势（p<0.05）。术后镇痛的吗啡等效物用量显著减少（p<0.05），直腿抬高（SLR）时间显著缩短（p<0.05）。两组在术后引流量、住院时间以及感染、恶心和呕吐等并发症方面无显著差异（p>0.05）。
多模式鸡尾酒关节周围注射中添加皮质类固醇可以减轻 TKA 后早期静息时的疼痛强度，增加膝关节的早期活动范围（ROM），减少术后镇痛药的用量，并缩短 SLR 所需的时间。然而，它对减少术后并发症和缩短住院时间没有影响。
