Guo Xiaobin, Ji Baochao, Zhang Xiaogang, Li Yicheng, Chen Quan, Cao Li
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
J Arthroplasty. 2025 Apr;40(4):1028-1033. doi: 10.1016/j.arth.2024.09.042. Epub 2024 Oct 5.
Cocktails containing glucocorticoids for local infiltration analgesia (LIA) are highly advocated and effective in managing pain in total joint arthroplasty (TJA). However, it remains ambiguous whether this protocol maintains its safety and efficacy in the treatment of periprosthetic joint infection (PJI), a devastating complication of TJA.
A retrospective study was conducted on 299 single-stage revision cases for PJI spanning the years 2010 to 2021. Of these, 127 received LIAs containing high-dose compound betamethasone (CB) were termed the CB group, and the other 172 were termed the non-CB group. The rates of re-infection and other postoperative complications, along with postoperative visual analog scale (VAS) scores, and opioid consumption were compared.
During minimum 2-year follow-up, there was no significant difference in the re-infection rate between the non-CB and CB groups (9.3 versus 8.7%; P = 0.85), consistent within the subsets of hip (8.4 versus 4.5%; P = 0.51) and knee (10.4 versus 13.3%; P = 0.60) PJIs individually. The administration of high-dose CB was neither an independent risk factor for reinfection (P > 0.05; 95% CI [confidence interval] including 1) nor was it associated with the occurrence of reinfection (P > 0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the CB group (P < 0.05). In the first 48-hour postoperative period, the CB group exhibited lower mean scores in both resting and movement VAS evaluations (P < 0.05). For knees, the movement VAS scores of the CB group remained lower even at 72 hours post-surgery (P < 0.001). Furthermore, within the first 72 hours post-surgery, the CB group required less additional opioid analgesics than the non-CB group (P < 0.05).
A LIA with a high-dose CB reduces postoperative pain, opioid consumption, and the incidence of PONV following a single-stage revision without affecting reinfection and other complication rates.
含糖皮质激素的鸡尾酒式局部浸润镇痛（LIA）在全关节置换术（TJA）疼痛管理中备受推崇且效果显著。然而，在治疗TJA的灾难性并发症假体周围关节感染（PJI）时，该方案是否仍能保持其安全性和有效性仍不明确。
对2010年至2021年期间299例PJI单阶段翻修病例进行回顾性研究。其中，127例接受含高剂量复方倍他米松（CB）的LIA治疗的患者被归为CB组，另外172例被归为非CB组。比较两组的再感染率和其他术后并发症发生率、术后视觉模拟评分（VAS）以及阿片类药物消耗量。
在至少2年的随访期内，非CB组和CB组的再感染率无显著差异（9.3%对8.7%；P = 0.85），在髋关节（8.4%对4.5%；P = 0.51）和膝关节（10.4%对13.3%；P = 0.60）PJI亚组中也是如此。高剂量CB的使用既不是再感染的独立危险因素（P > 0.05；95%置信区间[CI]包含1），也与再感染的发生无关（P > 0.05）。CB组术后恶心呕吐（PONV）的发生率显著较低（P < 0.05）。在术后48小时内，CB组在静息和活动VAS评估中的平均评分均较低（P < 0.05）。对于膝关节，CB组在术后72小时时的活动VAS评分仍较低（P < 0.001）。此外，在术后72小时内，CB组比非CB组所需的额外阿片类镇痛药更少（P < 0.05）。
含高剂量CB的LIA可减轻单阶段翻修术后的疼痛、阿片类药物消耗量及PONV发生率，且不影响再感染率和其他并发症发生率。
