Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chan PK (1), Chan CW (2), Chan TH (2) , Chan SH (2), Wong SC (3), Cheung CW (3) Fu H(1), A. Cheung A (4), Chan WK (4) Cheung MH (1), Chiu KY (1)
Affiliation :
(1) Department of Orthopaedics and Traumatology, The University of Hong Kong
(2)Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong, China
(3) Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
(4) Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong.
Introduction :
Total knee arthroplasty (TKA) is a cost-effective procedure, but 8% to 26.5% of patients have substantial postoperative pain. Periarticular corticosteroids (PAS) and intravenous corticosteroids (IVS) have been demonstrated to be effective in providing acute pain relief and better mobilization after TKA.
Objectives :
The present study aimed to compare pain relief and functional recovery after TKA among groups that received IVS, PAS, or a combination of both (IVSPAS). We hypothesized that patients receiving IVSPAS would report less postoperative pain and have better functional recovery than those receiving IVS, PAS, or a saline solution placebo (P) alone.
Methodology :
This randomized, double-blinded clinical trial in a local institution in Hong Kong recruited 178 patients who underwent primary unilateral TKA. Six of these patients were excluded because of changes in surgical technique; 4, because of their hepatitis B status; 2, because of a history of peptic ulcer; and 2, because they declined to participate in
the study.
Patients were randomized 1:1:1:1 to receive placebo (P), intravenous corticosteroids (IVS), periarticular corticosteroids (PAS), or a combination of intravenous and periarticular corticosteroids (IVSPAS)
Result & Outcome :
The pain scores at rest were significantly lower in the IVSPAS group than in the P group over the first 48 hours (p = 0.034) and 72 hours (p = 0.043) postoperatively. The pain scores during movement were also significantly lower in the IVS and IVSPAS groups than in the P group over the first 24, 48, and 72 hours (p < 0.023 for all). The flexion range of the operatively treated knee was significantly better in the IVSPAS group than in the P group on postoperative day 3 (p= 0.027). Quadriceps power was also greater in the IVSPAS group than in the P group on postoperative days 2 (p = 0.005) and 3 (p = 0.007). Patients in the IVSPAS group were able to walk significantly further than patients in the P group in the first 3 postoperative days (p < 0.003). Patients in the IVSPAS group also had a higher score on the Elderly Mobility Scale than those in the P group (p = 0.036).
IVS and IVSPAS yielded similar pain relief, but IVSPAS yielded a larger number of rehabilitation parameters that were significantly better than those in the P group. This study provides new insights into pain management and postoperative rehabilitation following TKA
