Search

Background: Glucocorticoids have been widely used in perioperative period for postoperative pain relief and the prevention of postoperative nausea and vomiting after total knee arthroplasty (TKA). However, the optimal administration protocols of glucocorticoids remain controversial. The purpose of this study is to compare the efficacy of glucocorticoids between intravenous and periarticular injection on clinical outcomes.Methods: A total of 114 patients were randomly assigned, and 46 patients in intravenous (IV) group and 47 patients in periarticular injection (PI) group were included in the final statistical analysis. The IV group received 10 mg dexamethasone intravenously, and the PI group received periarticular injection of cocktail including 10 mg dexamethasone during the procedure. The clinical outcomes were assessed using a visual analogue scale (VAS), the knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers and complications for all patients after TKA.Results: Patients in the IV group had similar VAS score at rest and during walking at 6 hours, 1st, 2nd, 3rd, 4th days, 2 weeks and 3 months postoperatively when compared to the PI group. The ROM of knee in the affected leg at post- operative 3 months was less in the IV group compared with the PI group (110.1°± 11.9°vs 115.4°± 13.5°, P = 0.047), but without a statistically significant difference at 3rd days and 2 weeks postoperatively. The knee swelling and KSS function score were not statistically different. The level of IL-6, CRP and ESR at postoperative 1st days and 3rd days were also similar in two groups. Vomiting and other complications occurrence were not significantly different between the two groups.Conclusion: The intraoperative intravenous and periarticular injection of glucocorticoids have similar clinical outcomes, including postoperative pain management, prevention of PONV, inflammation, knee swelling, knee function recovery and the incidence of complications following primary TKA.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000033490. Date of registration: June 2, 2020.