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Background: Glucocorticoids have been widely used in perioperative period for postoperative pain relief and the prevention of postoperative nausea and vomiting after total knee arthroplasty (TKA). However, the optimal administration protocols of glucocorticoids remain controversial. The purpose of this study is to compare the efficacy of glucocorticoids between intravenous and periarticular injection on clinical outcomes.Methods: A total of 114 patients were randomly assigned, and 46 patients in intravenous (IV) group and 47 patients in periarticular injection (PI) group were included in the final statistical analysis. The IV group received 10 mg dexamethasone intravenously, and the PI group received periarticular injection of cocktail including 10 mg dexamethasone during the procedure. The clinical outcomes were assessed using a visual analogue scale (VAS), the knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers and complications for all patients after TKA.Results: Patients in the IV group had similar VAS score at rest and during walking at 6 hours, 1st, 2nd, 3rd, 4th days, 2 weeks and 3 months postoperatively when compared to the PI group. The ROM of knee in the affected leg at post- operative 3 months was less in the IV group compared with the PI group (110.1°± 11.9°vs 115.4°± 13.5°, P = 0.047), but without a statistically significant difference at 3rd days and 2 weeks postoperatively. The knee swelling and KSS function score were not statistically different. The level of IL-6, CRP and ESR at postoperative 1st days and 3rd days were also similar in two groups. Vomiting and other complications occurrence were not significantly different between the two groups.Conclusion: The intraoperative intravenous and periarticular injection of glucocorticoids have similar clinical outcomes, including postoperative pain management, prevention of PONV, inflammation, knee swelling, knee function recovery and the incidence of complications following primary TKA.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000033490. Date of registration: June 2, 2020.

Background Revision total hip arthroplasty (THA) with large acetabular defect remains a challenge. Though trabecular metal (TM) cup and augments have been introduced in defect reconstruction with good result, the accurate positioning of implant is important to avoid complications. Therefore, we aimed to evaluate the usefulness of three-dimensional (3D) simulation and 3D model in assisting implant positioning during complex revision THA. Methods Sixteen patients (18 hips) who underwent revision THA with a Paprosky type III acetabular defect were analyzed retrospectively. Placement of acetabular cup and TM augments was simulated with 3D simulation software and 3D model preoperatively. Cup anteversion, abduction angle, and hip center were measured in each case preoperatively and postoperatively. Primary outcome was the percentage of outliers according to Lewinnek safe zone and Harris hip score (HHS). Secondary outcome was the correlation between the 3D planned and the postoperative value. Results The percentage of outliers was significantly corrected from 77.78% (14/18) preoperatively to 38.88% (7/18) postoperatively (p = 0.04). There was a significant correlation between mean planned cup anteversion and postoperative value (13.39 vs 11.99, r = 0.894; p < 0.001). There was a significant correlation between mean planned abduction and postoperative value (42.67 vs 44.91, r = 0.921, p < 0.001). The number of planned and used augments was the same in all the cases. In 15 cases (83.33%), the size of planned and used TM augments was the same. The HHS was significantly improved at final follow-up (80.94 vs 27.50, p < 0.001). No cases presented dislocation or radiological signs of loosening. Conclusion Preoperative 3D simulation and model were considered the useful method to assist implant positioning in revision THA with complex acetabular defect, with moderate to high accuracy and satisfied clinical outcome.