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Study shows safety, efficacy of periarticular steroid injection for pain management after TKA

Seah VWT, FRCSE. Singapore Med J. 2011; 52(1):19-23.

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A level 1 study indicates that adding a periarticular steroid injection to a pain management regimen that includes intraoperative injections of bupivacaine and epinephrine may lead to a shorter hospital stay and significantly less pain and morphine consumption after total knee arthroplasty.

In their 2-year prospective study, the investigators followed 100 patients who underwent total knee arthroplasty performed by three surgeons. The patients were randomized to receive either a periarticular infiltrative mixture of triamcinolone acetonide, bupivacaine and epinephrine or a solution of bupivacaine and epinephrine. The patients had the same postoperative regimen which included oral naproxen and patient-controlled analgesics.

In addition to discovering significantly lower pain scores and morphine use in the steroid group, the investigators found that the cohort had better range of motion compared to the control group.

“There was no increase in major complications such as infection or tendon rupture in the treatment group,” the authors wrote. At 2 years, they also found no significant differences between the groups regarding SF-36 and Oxford Knee Scores.