Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up.
We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised. The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group. The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.
Department of Orthopaedic Surgery, Singapore General Hospital, 1, Outram Road, Singapore, 169608, Singapore. pangheenee@hotmail.com
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Pang
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Yang
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Yeo
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000534:rehabilitation; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007430:Intraoperative Care / Q000379:methods; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
D000701:Analgesics, Opioid; D005938:Glucocorticoids; D009020:Morphine; D014222:Triamcinolone Acetonide