Periarticular Corticosteroid for Superior Pain Relief after Total Knee Arthroplasty: A Randomized Controlled Trial

Dexamethasone can alleviate pain and reduce inflammatory response following total knee arthroplasty (TKA). This study aimed to compare the effects of periarticular infiltration (PAI) and intravenous dexamethasone in patients who underwent TKA.

In this randomized controlled trial, 160 patients who underwent primary ipsilateral TKA were randomized into four groups: intravenous dexamethasone (group I, n = 40), topical dexamethasone (group T, n = 40), combined dexamethasone (group IT, n = 40), and a control group without dexamethasone (group C, n = 40). The primary outcome was the postoperative visual analog scale pain score. The secondary outcomes included opioid-equivalent consumption and active knee joint flexion. Tertiary outcomes were postoperative serum C-reactive protein and fasting glucose levels and the occurrence of adverse events such as wound edema or surgical site infection.

Patients in the PAI dexamethasone group experienced less pain on postoperative day (POD) one than the placebo group at rest (adjusted P = 0.035) and during exercise (adjusted P = 0.028). On POD two and three, they experienced less pain compared to the intravenous group during exercise. Patients in the intravenous group showed easier knee flexion on POD one compared to the control group (P = 0.016). All dexamethasone groups had lower C-reactive protein levels than the control group on POD two. No patient who received dexamethasone experienced hyperglycemia or wound problems.

Local dexamethasone administration during surgery alleviated pain better than intravenous dexamethasone after TKA. Both local and intravenous administration of dexamethasone can reduce the postoperative inflammatory response without increasing the risk of infection.