Periarticular Versus Intravenous Corticosteroids in Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Objectives: Despite the extensive research revolving around total knee arthroplasty (TKA), the optimal steroid administration route remains unclear. This study aimed to compare the clinical efficacy of intravenous (IV) to periarticular (PA) steroid administration in TKA.Methods: Embase, PubMed, Cochrane, and Google Scholar were searched till April 2024 for randomized controlled trials (RCT) comparing IV to PA steroids in TKA. Each trial was assessed using the Cochrane risk-of-bias tool and classified as having a High, Low, or Unclear risk of bias. The clinical outcomes of interest were post-operative pain (reported as the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS)), vomiting, post-operative range of motion (reported as knee flexion angle), post-operative IL-6 and CRP, and glucose levels. Post-operative complications such as surgical site or deep infections, and wound dehiscence following TKA were also recorded and assessed.Results: Five RCTs with a total of 501 patients were included in this review. There were no significant differences in pain at rest on post-operative day (POD) 1 and 2 and during activity between PA and IV administration, while pain at rest on POD 3 was lower in the PA group (I2 =38% SMD=-0.27; 95% CI: -0.5, -0.04, P=0.02). Post-operative complications, knee flexion, and laboratory values such as IL-6, CPR, and glucose showed no significant difference between the groups, while vomiting rates were significantly higher in the PA group (I2= 0% OR=2.43; 95% CI: 1.36–4.35, P=0.003).Conclusion: PA and IV peri-operative administration of glucocorticoids in TKA have similar clinical outcomes in inflammation reduction, knee flexion function, adverse event rates, and post-operative pain at rest during the first 48 hours post-operatively and at activity, while the PA group is associated with lower pain at rest on POD 3 and a higher rate of post-operative vomiting. Level of evidence: II