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Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis.

Zhao X, Qin J, Tan Y, Mohanan R, Hu D, Chen L - J Orthop Surg Res (2015)

Bottom Line: In addition, steroids did not decrease the postoperative drainage through the reduction of prostaglandins (P >0.05).For patients undergoing TKA, the addition of steroids to MCPI improved the analgesic effect and was proved to be highly safe.However, MCPI with steroids neither increased the early postoperative range of motion (ROM) or the long-term ROM of knee, nor did it reduce the postoperative drainage.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. 478252553@qq.com.

ABSTRACT

Background: Total knee arthroplasty (TKA) has been reported to be the most successful treatment for patients with advanced osteoarthritis, however, early postoperative pain has become an unresolved issue. The aim of this Meta-analysis is to evaluate the efficacy and safety of steroid addition to multimodal cocktail periarticular injection (MCPI) in patients undergoing TKA.

Method: Clinical randomized controlled trials concerning the efficacy and safety of MCPI containing steroids in TKA published up to December 2014 were retrieved from PubMed, Cochrane library, EMbase databases. The methodological quality of the included studies was assessed by the 12-item scale. Data analysis was performed using StataSE12.0.

Results: Six randomized controlled trials involving a total of 567 patients were assessed; the steroid group included 305 patients, and the control group included 262 patients. The meta-analysis showed that MCPI with steroids in TKA significantly reduced postoperative pain; duration of time required to perform straight-leg raising and length of hospital stay was (P < 0.05). Neither the early postoperative nor the long-term range of motion of knee showed any statistical difference between the non-steroid and steroid group (P >0.05). For safety, steroids did not increase the incidence of postoperative infection and wound oozing (P >0.05); no tendon rupture was reported up to now. In addition, steroids did not decrease the postoperative drainage through the reduction of prostaglandins (P >0.05).

Conclusion: For patients undergoing TKA, the addition of steroids to MCPI improved the analgesic effect and was proved to be highly safe. The duration of time required to perform straight-leg raising and length of hospital stay was significantly reduced. However, MCPI with steroids neither increased the early postoperative range of motion (ROM) or the long-term ROM of knee, nor did it reduce the postoperative drainage. However, the best results are acquired in patients without any altered immunological status.

No MeSH data available.


Related in: MedlinePlus

Comparison of knee ROM between the steroid and control group at 3 months postoperatively
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Fig5: Comparison of knee ROM between the steroid and control group at 3 months postoperatively

Mentions: ROM at postoperative days 1, 2, 3, and month 3 was reported in four of the six studies [10, 12, 14, 15]. Heterogeneity was detected in every postoperative period. Sensitivity analysis and subgroup analysis failed to eliminate the heterogeneity. The random-effects model was selected for the reason that no matter what the exclusion or inclusion of every study, the results were all the same and had clinical agreement. The results of meta-analysis showed that the ROM of knee at postoperative days 1, 2, 3, and month 3 did not show any significant difference between the steroid group and the control group (P > 0.05, Figs. 2, 3, 4, and 5).Fig. 2


Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis.

Zhao X, Qin J, Tan Y, Mohanan R, Hu D, Chen L - J Orthop Surg Res (2015)

Comparison of knee ROM between the steroid and control group at 3 months postoperatively
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4443605&req=5

Fig5: Comparison of knee ROM between the steroid and control group at 3 months postoperatively
Mentions: ROM at postoperative days 1, 2, 3, and month 3 was reported in four of the six studies [10, 12, 14, 15]. Heterogeneity was detected in every postoperative period. Sensitivity analysis and subgroup analysis failed to eliminate the heterogeneity. The random-effects model was selected for the reason that no matter what the exclusion or inclusion of every study, the results were all the same and had clinical agreement. The results of meta-analysis showed that the ROM of knee at postoperative days 1, 2, 3, and month 3 did not show any significant difference between the steroid group and the control group (P > 0.05, Figs. 2, 3, 4, and 5).Fig. 2

Bottom Line: In addition, steroids did not decrease the postoperative drainage through the reduction of prostaglandins (P >0.05).For patients undergoing TKA, the addition of steroids to MCPI improved the analgesic effect and was proved to be highly safe.However, MCPI with steroids neither increased the early postoperative range of motion (ROM) or the long-term ROM of knee, nor did it reduce the postoperative drainage.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. 478252553@qq.com.

ABSTRACT

Background: Total knee arthroplasty (TKA) has been reported to be the most successful treatment for patients with advanced osteoarthritis, however, early postoperative pain has become an unresolved issue. The aim of this Meta-analysis is to evaluate the efficacy and safety of steroid addition to multimodal cocktail periarticular injection (MCPI) in patients undergoing TKA.

Method: Clinical randomized controlled trials concerning the efficacy and safety of MCPI containing steroids in TKA published up to December 2014 were retrieved from PubMed, Cochrane library, EMbase databases. The methodological quality of the included studies was assessed by the 12-item scale. Data analysis was performed using StataSE12.0.

Results: Six randomized controlled trials involving a total of 567 patients were assessed; the steroid group included 305 patients, and the control group included 262 patients. The meta-analysis showed that MCPI with steroids in TKA significantly reduced postoperative pain; duration of time required to perform straight-leg raising and length of hospital stay was (P < 0.05). Neither the early postoperative nor the long-term range of motion of knee showed any statistical difference between the non-steroid and steroid group (P >0.05). For safety, steroids did not increase the incidence of postoperative infection and wound oozing (P >0.05); no tendon rupture was reported up to now. In addition, steroids did not decrease the postoperative drainage through the reduction of prostaglandins (P >0.05).

Conclusion: For patients undergoing TKA, the addition of steroids to MCPI improved the analgesic effect and was proved to be highly safe. The duration of time required to perform straight-leg raising and length of hospital stay was significantly reduced. However, MCPI with steroids neither increased the early postoperative range of motion (ROM) or the long-term ROM of knee, nor did it reduce the postoperative drainage. However, the best results are acquired in patients without any altered immunological status.

No MeSH data available.


Related in: MedlinePlus