Effect of Methylprednisolone in Periarticular Infiltration for Primary Total Knee Arthroplasty on Pain and Rehabilitation

Background: Optimal pain management after total knee arthroplasty (TKA) is important to ensure timely rehabilitation and patient satisfaction. This study examines the efficacy of adding corticosteroid in periarticular infiltration cocktail with relation to postoperative pain management and rehabilitation in patients undergoing simultaneous bilateral TKA. Methods: Fifty patients with symptomatic end-stage bilateral knee osteoarthritis undergoing bilateral TKA under the same anesthetic were recruited. More painful knee was operated first, and the study solution containing ropivacaine, clonidine, epinephrine, and ketorolac with methylprednisolone was infiltrated in one knee and an identical mixture but without methylprednisolone was infiltrated in the second knee. Outcome measures included comparison of visual analogue scale on movement of each knee and range of motion achieved during the first three days after surgery. Results: Differences invisual analogue scale score and range of motion at day one and three between the two groups of knees were significant (P <.05). Postoperative inflammation and the ability to straight leg raise showed better trends in the knees receiving prednisolone although this did not reach statistical significance. Conclusion: Addition of methylprednisolone to periarticular infiltration cocktail for patients undergoing TKA has significant influence on reduction of pain in the early postoperative period and patients are able to regain knee flexion more quickly. (C) 2019 Elsevier Inc. All rights reserved.