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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 the period of time required to perform a straight-leg raise between the steroid and control group
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Fig7: Comparison of the period of time required to perform a straight-leg raise between the steroid and control group

Mentions: The period of time required to perform a straight-leg raise was reported in two [12, 15] of the six papers, including 126 patients in the steroid group and 126 patient in the control group. The fixed-effects model was selected as no significant heterogeneity was found (P = 0.669, I2 = 0 %). The result of meta-analysis indicated that patients in the steroid group could perform a straight-leg raise significantly earlier than those in the control group (WMD = −0.590, 95 % CI, −0.829 ~ −0.351, P < 0.001, Fig. 7).Fig. 7


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 the period of time required to perform a straight-leg raise between the steroid and control group
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig7: Comparison of the period of time required to perform a straight-leg raise between the steroid and control group
Mentions: The period of time required to perform a straight-leg raise was reported in two [12, 15] of the six papers, including 126 patients in the steroid group and 126 patient in the control group. The fixed-effects model was selected as no significant heterogeneity was found (P = 0.669, I2 = 0 %). The result of meta-analysis indicated that patients in the steroid group could perform a straight-leg raise significantly earlier than those in the control group (WMD = −0.590, 95 % CI, −0.829 ~ −0.351, P < 0.001, Fig. 7).Fig. 7

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