Highlights
- •Preoperative intra-articular steroid does not reduce acute pain after total knee arthroplasty.
- •Intra-articular steroid reduces preoperative joint interleukin-6.
- •Intra-articular steroid does not reduce postoperative sensitization.
Abstract
In a randomized, double-blind, placebo controlled trial, we investigated the postoperative
analgesic effect of a single intra-articular injection of 40 mg methylprednisolone
acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight
patients with high pain osteoarthritis (≥5 on a numeric rating scale during walk)
and sensitization (pressure pain threshold <250 kPa), aged 50 to 80 years and scheduled
for primary unilateral TKA under spinal anaesthesia were included. The primary outcome
was the proportion of patients with moderate/severe pain during a 5-m walk test 24
hours postoperatively. Secondary outcomes included pain at 48 hours, during the first
14 days, sensitization (quantitative sensory testing with pressure pain threshold
and wind-up from temporal summation), and inflammatory changes (systemic C-reactive
protein, intra-articular interleukin [IL]-6). No difference in the proportion of patients
with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and
74%, χ2 = .2, P = .63, odds ratio = .7, 95% confidence interval = .2–2.8) or at 48 hours (57% and
68%, χ2 = .5, P = .46, odds ratio = .6, 95% confidence interval = .2–2.3), and no difference between
groups in postoperative sensitization was found (P > .4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP
group versus placebo (median change in IL-6 = −70 pg/mL, interquartile range = −466
to 0 vs. 32 pg/mL, interquartile range = −26 to 75, P = .029). Alternative central or peripheral analgesic interventions in this high-risk
group are required.
Perspective
Peripherally driven inflammatory pain and nociceptive changes before TKA has been
suggested to be a cause for increased acute postoperative pain. However, preoperative
intra-articular MP in patients with high pain osteoarthritis and sensitization did
not reduce acute post-TKA pain or sensitization despite a preoperative reduction of
intra-articular inflammatory markers.
Key words
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Article info
Publication history
Published online: August 22, 2017
Accepted:
July 25,
2017
Received in revised form:
June 22,
2017
Received:
April 24,
2017
Footnotes
Disclosure: The authors declare no conflict of interest. The study was supported by a grant from the Lundbeck Foundation, Hellerup Denmark (grant number: R25-A2702). The foundation is independent of the pharmaceutical company Lundbeck a/s and was not involved in designing or conducting the study.
This study was registered at ClinicalTrials.gov (NCT02253966) before patient enrollment.
Identification
Copyright
© 2017 by the American Pain Society
