Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Background: Local injection of a multimodal cocktail including corticosteroid is commonly used for postoperative pain following total knee arthroplasty (TKA). However, it is inconclusive whether additional corticosteroid is beneficial. This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy of an additional, local injection of corticosteroid in terms of pain relief and knee function recovery after TKA.

Methods: RCTs in electronic literature databases including PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Of 1,628 records identified, 9 RCTs involving 727 knees were eligible for data extraction and meta-analysis.

Results: Local injection of a multimodal cocktail including corticosteroid did not contribute to pain relief within 12 hours postoperatively (P > 0.05). However, from 24 hours to 72 hours, it significantly decreased pain scores (P < 0.05, all) at rest and reduced total rescue opioid consumption postoperatively (P < 0.05). Knee range of motion (ROM) was improved at postoperative day 1 (POD1) and POD2 (P < 0.05), and hospital stay (P < 0.05) was shortened after local injection of corticosteroid. However, the other outcomes, including knee ROM after POD2, C-reactive protein level, Knee Society score, postoperative nausea and vomiting, and wound complication occurrences, were not significantly different (P > 0.05, all).

Conclusions: Additional corticosteroid added to a multimodal cocktail improved postoperative pain, enhanced knee functional recovery, and shortened hospital stays following TKA, but local injection of corticosteroids had no effect on reducing nausea and vomiting based on our outcomes.