Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial


  • Ankit Thora Shalby Hospitals, Indore, Madhya Pradesh, India
  • Ashok Bhatt MGM Medical College and M.Y Hospital, Indore, Madhya Pradesh, India
  • Nishit Bhatnagar Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
  • Anurag Tiwari AIIMS, Bhopal, Madhya Pradesh, India
  • Mukul Mohindra Central Institute of Orthopaedics, Safdarjung Hosptal, New Delhi, India



Periarticular injection, Total knee arthroplasty, Pain


Background: Multimodal periarticular cocktail injection (MPCI) containing local anesthetics, adrenaline, and anti-inflammatory agents such as NSAIDS have been promising in terms of quick functional recovery. This study evaluates the efficiency of steroid as a component of MPCI in knee arthroplasty.

Methods: This is a prospective, double-blind, RCT where 36 patients with osteoarthritis were included and randomized to receive MPCI either with steroid or without steroid. Pain was evaluated by visual analogue scale (VAS) at preoperative and postoperatively at rest, and during activity. The range of motion of the knee was looked for in a similar way. The amount of NSAIDs and the duration of NSAID usage were noted till the last follow-up.

Results: Both non-steroid and steroid groups were similar with regard to VAS at rest and during activity, or range of motion, at all postoperative observations. The postoperative knee society knee score in the steroid group improved significantly as compared to that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; p<0.0045) and three-month follow-up (90.2±16.3 and 72.5±16.6; p<0.0027), but no significant difference was noted at six-month follow up. There was no significant difference in consumption of NSAIDs within 72 hours between the two groups. The duration of piroxicam usage in patients in the steroid group was significantly shorter than that in the non-steroid group, (7.2±0.7) compared with (10.5±1.9) weeks; =0.012.

Conclusions: The Study validates usage of steroid in MPCI due to faster rehabilitation and less consumption of NSAIDs and no additional risk of post-operative complications. 


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