title: Efficacy of steroid addition to multimodal cocktail periarticular injection in total knee arthroplasty: a meta-analysis.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.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.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. 757599061@qq.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Qin
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. 313237115@qq.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. 860136551@qq.com.
authors.forename: Rahul
authors.initials: R
authors.lastname: Mohanan
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. hudongcai11@163.com.
authors.forename: Dongcai
authors.initials: D
authors.lastname: Hu
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, School of Medicine, Wuhan University, 169 Donghu Road, Wuhan, Hubei Province , 430071, China. lbchen@whu.edu.cn.
authors.forename: Liaobin
authors.initials: L
authors.lastname: Chen
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D020370:Osteoarthritis, Knee / Q000601:surgery; D010149:Postoperative Pain / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids