Safety of steroid-containing cocktail periarticular injection after knee arthroplasty: a meta-analysis.

BACKGROUND: Steroids have strong anti-inflammatory, anti-emetic and analgesic effects and are widely used in perioperative analgesia. Studies have shown that periarticular injection of steroid-containing cocktail analgesic therapy in knee arthroplasty can relieve postoperative pain, improve knee activity, and reduce complications. However, the other studies show that steroids can increase the risk of postoperative infection, and tendon rupture. Therefore, the safety and efficacy of steroid-containing cocktail periarticular injection in knee arthroplasty is still controversial. OBJECTIVE: To evaluate the safety and efficacy of steroid-containing cocktail periarticular injection after knee arthroplasty by meta-analysis. METHODS: The published literatures were searched on the databases of PubMed/Medline, Cochrane Central Register of Controlled Trials, and EMBASE until April 2019. All randomized controlled trials of topical steroid analgesia after knee arthroplasty were collected and eligible articles were screened. Two researchers independently assessed the risk of bias and methodological quality of included studies by the Cochrane 5.0. The outcome data were extracted and a meta-analysis was conducted by Review Manager 5.2 software. RESULTS AND CONCLUSION: (1) A total of 10 randomized controlled articles involving 820 patients were included. (2) The meta-analysis showed that visual analogue scale score was lower in the steroid group than in the control group at postoperative 1 day [MD=-1.52, 95%CI(-2.94, -0.1 0}, P=0.04]. Motion range was higher in the steroid group than in the control group at postoperative 1, 2, 3, 4 and 5 days [MD=11.57, 95%CI(9.85, 13.30}, P< 0.000 01; MD-9.03, 95%CI(6.67, 11.38}, P< 0.000 01; MD-5.73, 95%CI(0.85, 10.60}, P=0.02; MD-5.53, 95%CI(0.68, 10.38), P=0.03}; MD=5.90, 95%CI(0.87, 10.93), P=0.02]. Morphine use was less in the steroid group than in the control group [MD=-7.94, 95%CI(-14.35, -1.53), P=0.02]. Hospital stay was shorter in the steroid group than in the control group [MD=-<>.98, 95%CI(-1.25, -0.71 ), P < 0.000 01]. Straight leg raising took less time in the steroid group than in the control group [MD=0.65, 95%CI(-0.86, 0.44), P < 0.000 01]. Postoperative C-reactive protein level was lower in the steroid group than in the control group [WMD=-4.82, 95%CI(7.41, 2.23), P=0.000 3]. Knee society score and complication rate were not significantly different between the two groups. (3) To conclude, the periarticular injection of steroid-containing cocktails after knee arthroplasty is safe and effective. [ABSTRACT FROM AUTHOR]