Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2015

01-08-2015 | Knee

The efficacy of steroid injection in total knee or hip arthroplasty

Authors: Zhaohui Cui, Xue Liu, Yuanjun Teng, Jin Jiang, Jing Wang, Yayi Xia

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2015

Login to get access

Abstract

Purpose

A systematic review and meta-analysis based on randomized controlled trials (RCTs) was conducted to evaluate the efficacy and safety of steroid injection in total knee or hip arthroplasty (TKA/THA).

Methods

A systematical electronic search identified the relevant RCTs in the databases of PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials. Two reviewers independently completed data collection and assessment of methodological quality. Meta-analysis was performed for the outcomes of visual analogue pain score, range of motion (ROM), postoperative nausea and vomiting (PONV), morphine consumption, length of stay and complications.

Results

A total of 863 participants were enrolled. Patients who received steroid injection had a significant reduction in the incidence of PONV and improvement in short-term pain score, and ROM (p < 0.05). Regarding morphine consumption and hospitalization time, the steroid group showed a significant reduction in TKA but no statistically significant difference in THA. In addition, there were no significant differences in complications (n.s.).

Conclusions

The current evidence suggests that steroid injection in TKA/THA provides short-term advantages in pain relief and antiemetic effects. The optimal dose and long-term effects of steroid injection still require numerous studies.

Level of evidence

II.
Literature
1.
Armstrong RW, Bolding F, Joseph R (1992) Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 8:213–223PubMedCrossRef
2.
Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA (1996) Intra-articular injection of bupivacaine in knee-replacement operations: results of use for analgesia and for preemptive blockade. J Bone Joint Surg Am 78:734–738PubMed
3.
4.
Bergeron SG, Kardash KJ, Huk OL (2009) Perioperative dexamethasone does not affect functional outcome in total hip arthroplasty. Clin Orthop Relat Res 467:1463–1467PubMedCentralPubMedCrossRef
5.
Browne C, Copp S, Reden L, Pulido P, Colwell C Jr (2004) Bupivacaine bolus injection versus placebo for pain management following total knee arthroplasty. J Arthroplasty 19:377–380PubMedCrossRef
6.
Chia SK, Wernecke GC, Harris IA, Bohm MT, Chen DB, Macdessi SJ (2013) Peri-articular steroid injection in total knee arthroplasty: a prospective, double blinded, randomized controlled trial. J Arthroplasty 28:620–623PubMedCrossRef
7.
Christensen CP, Jacobs CA, Jennings HR (2009) Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial. J Bone Joint Surg Am 91:2550–2555PubMedCrossRef
8.
9.
De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588PubMedCrossRef
10.
Fitzgerald RH Jr (1976) Intrasynovial injection of steroids uses and abuses. Mayo Clin Proc 51:655–659PubMed
11.
Flower RJ, Rothwell NJ (1994) Lipocortin-1: cellular mechanisms and clinical relevance. Trends Pharmacol Sci 15:71–76PubMedCrossRef
12.
Fu P, Wu Y, Wu H, Li X, Qian Q, Zhu Y (2009) Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. Knee 16:280–284PubMedCrossRef
13.
Gray RG, Gottlieb NL (1983) Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res 177:235–263PubMed
14.
15.
16.
Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef
17.
Hunter JA, Blyth TH (1999) A risk-benefit assessment of intra-articular corticosteroids in rheumatic disorders. Drug Saf 21:353–365PubMedCrossRef
18.
Ikeuchi M, Kamimoto Y, Izumi M, Fukunaga K, Aso K, Sugimura N, Yokoyama M, Tani T (2013) Effects of dexamethasone on local infiltration analgesia in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-013-2367-5
19.
Jokela RM, Ahonen JV, Tallgren MK, Marjakangas PC, Korttila KT (2009) The effective analgesic dose of dexamethasone after laparoscopic hysterectomy. Anesth Analg 109:607–615PubMedCrossRef
20.
Kardash KJ, Sarrazin F, Tessler MJ, Velly AM (2008) Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty. Anesth Analg 106:1253–1257PubMedCrossRef
21.
Kerr DR, Kohan L (2008) Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 79:174–183PubMedCrossRef
22.
Liu K, Hsu CC, Chia YY (1999) The effect of dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg 89:1316–1318PubMedCrossRef
23.
Lunn TH, Andersen LØ, Kristensen BB, Husted H, Gaarn-Larsen L, Bandholm T, Ladelund S, Kehlet H (2013) Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth 110:66–73PubMedCrossRef
24.
Lunn TH, Kehlet H (2013) Perioperative glucocorticoids in hip and knee surgery—benefit vs. harm? A review of randomized clinical trials. Acta Anaesthesiol Scand 57:823–834PubMedCrossRef
25.
Lunn TH, Kristensen BB, Andersen LØ, Husted H, Otte KS, Gaarn-Larsen L, Kehlet H (2011) Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth 106:230–238PubMedCrossRef
26.
Madan R, Bhatia A, Chakithandy S, Subramaniam R, Rammohan G, Deshpande S, Singh M, Kaul HL (2005) Prophylactic dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: a dose ranging and safety evaluation study. Anesth Analg 100:1622–1626PubMedCrossRef
27.
Mathiesen O, Jacobsen LS, Holm HE, Randall S, Adamiec-Malmstroem L, Graungaard BK, Holst PE, Hilsted KL, Dahl JB (2008) Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth 101:535–541PubMedCrossRef
28.
Ng YC, Lo NN, Yang KY, Chia SL, Chong HC, Yeo SJ (2011) Effects of periarticular steroid injection on knee function and the inflammatory response following unicondylar knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:60–65PubMedCrossRef
29.
Pang HN, Lo NN, Yang KY, Chong HC, Yeo SJ (2008) Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up. J Bone Joint Surg Br 90:738–744PubMedCrossRef
30.
Sauerland S, Nagelschmidt M, Mallmann P, Neugebauer EA (2000) Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review. Drug Saf 23:449–461PubMedCrossRef
31.
Sean VW, Chin PL, Chia SL, Yang KY, Lo NN, Yeo SJ (2011) Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial. Singap Med J 52:19–23
32.
33.
Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM (2000) The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg 91:1404–1407PubMedCrossRef
34.
Yue DB, Wang BL, Liu KP, Guo WS (2013) Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty. Chin Med J (Engl) 126:3851–3855
Metadata
Title
The efficacy of steroid injection in total knee or hip arthroplasty
Authors
Zhaohui Cui
Xue Liu
Yuanjun Teng
Jin Jiang
Jing Wang
Yayi Xia
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3049-7

Other articles of this Issue 8/2015

Knee Surgery, Sports Traumatology, Arthroscopy 8/2015 Go to the issue

Knee

Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments

Knee

Variability of tunnel positioning in fluoroscopic-assisted ACL reconstruction

Knee

In vitro comparison between cortical and cortico-cancellous femoral suspension devices for anterior cruciate ligament reconstruction: implications for mobilization

Knee

Associations of isokinetic knee steadiness with hop performance in patients with ACL deficiency

Ankle

Outcome of subtalar instability reconstruction using the semitendinosus allograft tendon and biotenodesis screws

Ankle

T2-mapping at 3 T after microfracture in the treatment of osteochondral defects of the talus at an average follow-up of 8 years