Page 224 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F8.3 Young HA Investigators Session 14:30 Room 421

Long term effect of Steroid in Local Infiltration Analgesia after Total Knee Arthroplasty. A Paired-randomised
Controlled Study
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Chan WKV , Chan PK , Chiu KY , Yan CH , Fu CH , Chan CW 2
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1 Division of Joint Replacement Surgery, Department of Orthopaedics and Traumatology, Department of Anaesthesiology, The
University of Hong Kong, Hong Kong
Introduction
Total knee arthroplasty (TKA) is the most successful treatment for advance osteoarthritis; however, severe post-operative
pain remains unresolved. Sufficient analgesia is important for immediate mobilisation and rehabilitation. Local infiltration
analgesia (LIA) is effective in relieving pain after TKA, however, the optimal cocktail combination and its individual roles are
unclear. Corticosteroid in LIA has shown to improve early rehabilitation outcomes, however, its long term effect and safety is
uncertain.
Objectives
To evaluate the long term effects and safety of steroid in LIA.

Methodology
This is a paired-randomised controlled study approved by Institutional Review Board. Patients undergoing one-stage bilateral
TKA were recruited. Peri-operative analgesics were standardised. LIA containing ropivacaine, ketorolac, adrenaline with or
without triamcinolone was given. Each knee of same patient was randomised to receive LIA with or without steroid.

Primary outcome includes differences in complications and functional scorings (Knee Society Score (KSS) and Oxford
Knee Score (OKS)) up to one year follow-up. Secondary outcome includes differences in Visual Analogue Scale (VAS) and
rehabilitation parameters between both knees of same patient.
Results
45 patients (90 TKAs) were included. LIA with steroid knees showed significantly lower VAS at rest and during activity from
day one to six weeks (p<0.05). Active and passive knee range was greater in steroid treated knee from day one to day seven
(p<0.05). Time to active straight leg raise was shorter in steroid group (p<0.05). Up to one year follow-up, no infection, wound
complications or tendon ruptures in all knees. KSS and OKS were comparable at one year.

Conclusion
Steroid in LIA can improve early pain control and recovery after TKR, while no increase in long term complications were
found. It is effective and safe. This has important clinical significance in setting of fast-track arthroplasty.

Tuesday, 8 May 2018

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