Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR.
Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR.
J Bone Joint Surg Am. 2023 Jun 21;105(12):924-932. doi: 10.2106/JBJS.22.01218. Epub 2023 May 23.
Total knee arthroplasty (TKA) is a cost-effective procedure, but it is also associated with substantial postoperative pain. The present study aimed to compare pain relief and functional recovery after TKA among groups that received intravenous corticosteroids, periarticular corticosteroids, or a combination of both.
This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in the study. Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS).
The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p ≤ 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p = 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p ≤ 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036).
IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA.
Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术（TKA）是一种具有成本效益的手术，但也会引起大量的术后疼痛。本研究旨在比较接受静脉内皮质类固醇、关节周围皮质类固醇或两者联合治疗的 TKA 患者的疼痛缓解和功能恢复情况。
本研究是在香港一家本地机构进行的随机、双盲临床试验，共招募了 178 名接受单侧初次 TKA 的患者。其中 6 名患者因手术技术改变而被排除；4 名患者因乙型肝炎状态而被排除；2 名患者因消化性溃疡病史而被排除；2 名患者因拒绝参与研究而被排除。患者以 1:1:1:1 的比例随机分为安慰剂（P）组、静脉内皮质类固醇（IVS）组、关节周围皮质类固醇（PAS）组或静脉内和关节周围皮质类固醇联合（IVSPAS）组。
在术后 48 小时（p = 0.034）和 72 小时（p = 0.043）时，IVSPAS 组的静息时疼痛评分明显低于 P 组。在运动时，IVS 和 IVSPAS 组的疼痛评分也明显低于 P 组，在术后 24、48 和 72 小时时，p ≤ 0.023（均为 P 值）。在术后第 3 天，IVSPAS 组患者的膝关节活动度明显优于 P 组（p = 0.027）。在术后第 2 天（p = 0.005）和第 3 天（p = 0.007），IVSPAS 组的股四头肌力量也明显大于 P 组。在术后 3 天内，IVSPAS 组患者的行走距离明显长于 P 组（p ≤ 0.003）。IVSPAS 组患者的老年活动量表评分也高于 P 组（p = 0.036）。
IVS 和 IVSPAS 都能达到相似的止痛效果，但 IVSPAS 产生了更多的康复参数，明显优于 P 组。本研究为 TKA 术后疼痛管理和康复提供了新的见解。
治疗性 I 级。请参阅《作者须知》，以获取完整的证据水平描述。
