Steroid Versus Non-steroid Intraoperative Multimodal Periarticular Injection in Simultaneous Bilateral Total Knee Arthroplasty Using Real Intelligence CORI: Comparative Observational Study on Postoperative Pain and Early Functional Recovery.

AIMS AND OBJECTIVES

This study aimed to compare the postoperative pain, early knee range of flexion, and straight leg raise (SLR) outcomes between the right and left knees in patients undergoing simultaneous bilateral primary total knee arthroplasty (TKA). The primary objective of this study was to investigate the comparative effects of a multimodal periarticular cocktail injection injected intraoperatively to both knees, with a specific focus on the impact of adding methylprednisolone to the injection administered to the right knee.

MATERIALS AND METHODS

This prospective observational comparative study enrolled 30 patients (60 knees) who underwent simultaneous bilateral primary TKA. Following strict inclusion and exclusion criteria, all patients were carefully selected for participation. Intraoperatively, a multimodal periarticular cocktail mixture was injected into both knees prior to final implantation. Notably, the right-sided mixture contained methylprednisolone (80 mg). Postoperative follow-up assessments focused on evaluating Visual Analog Scale (VAS) pain scores, degree of range of flexion, and degree of SLR.

RESULTS

The study sample consisted of patients with a mean age of 61.07 years, exhibiting a female-to-male ratio of 16.6:1. Our study demonstrated a significant reduction in VAS scores for the right knee compared to the left knee at all post-operative time points (12, 24, 48, and 72 hours), with p-value < 0.001. Early functional recovery, assessed by knee flexion and SLR, showed improved outcomes in the right knee. At 24, 48, and 72 hours post-operation, the right knee demonstrated a significantly greater range of motion (ROM) compared to the left knee (p < 0.05). The right knee exhibited significantly higher active SLR values than the left knee at 24, 48, and 72 hours post-operation, with statistically significant differences (p < 0.05).

CONCLUSION

This study demonstrated that the adjunctive use of methylprednisolone in a periarticular intraoperative multimodal cocktail injection significantly improved the postoperative pain and functional outcomes following TKA. Specifically, the addition of methylprednisolone resulted in reduced postoperative pain scores with increased ROM (degrees) and greater active SLR (degrees) compared to the conventional multimodal periarticular cocktail injection.