Introduction
Compared to conservative management alone, patients with moderate-to-severe knee osteoarthritis treated with total knee arthroplasty showed a better pain relief and functional outcome. However, post-operative pain relief remains an important challenge. Considering steroid as an adjunct to the multimodal analgesic regime, it can reduce post-operative inflammation and surgical stress response. However, the effect of systemic steroids on post-operative pain control for total knee arthroplasty in Chinese population has yet been studied. Majority of the randomized-controlled trials focused on post-operative control of pain, nausea and vomiting, the data for improvement in range of movement in total knee arthroplasty was scarce. No studies investigated on patient’s satisfaction towards post-operative pain control with intravenous steroids in total knee arthroplasty.
Objectives
The aim of this study was to investigate the effect of pre-operative high dose methylprednisolone on pain relief and recovery after total knee arthroplasty in Chinese population.
Methodology
This is a prospective, randomized, double-blinded, placebo controlled single-centre trial. 60 patients undergoing elective primary unilateral total knee arthroplasty during June 2017 to March 2018 were randomized into intervention and control group. The pre-operative, intra-operative and post-operative anesthetic and analgesic regimes were standardized. The intervention group received an additional of 125mg methylprednisolone intravenously on induction of anesthesia. Subjects were assessed at 24, 30, 48 hours after surgery and upon discharge by physiotherapists. In each assessment, rest pain and pain on movement from operated knee were assessed with 100mm visual analogue scale. Range of movement from operated knee was also charted. Patient's satisfaction were documented. C-reactive protein level before and after operation was calculated. Adverse reactions were documented. Subjects were followed up at 6 weeks and 4 months.
Results & Outcome
Rest pain and pain on movement, including straight knee raise, maximal knee flexion and walking with frame for 5 metres, were significantly reduced in the methylprednisolone group at 24 and 30 hours after surgery then the placebo group (ANOVA p=0.030, p=0.003, p=0.032, p=0.010 respectively). The methylprednisolone group demonstrated a greater range of movement from the operated knee at 24-hour and 30-hour post-operative assessment (ANOVA p=0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p< 0.001). Patient's satisfaction was higher in methylprednisolone group(p< 0.001). Incidences of hypokalaemia, hyperglycaemia and sleep disturbance were not statistically significant. No wound complications were noted at 6-week and 4-month follow-up. Pre-operative intravenous methylpredinsone can improve post-operative pain and range of movement after total knee arthroplasty. It can act as an effective adjunct in the multi-modal analgesic regime.
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