The Effect of Adding Corticosteroid to the Periarticular Injection Cocktail for Pain Control after Total Hip and Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial

Background: The impact of periarticular corticosteroid injection for pain control after total joint arthroplasty (TJA) iscontroversial. The present study aimed to investigate this controversy in patients undergoing total hip arthroplasty(THA) and total knee arthroplasty (TKA).Methods: A total of 42 THA and 42 TKA patients were included in this study. The patients of each group were randomlyallocated into group A (cocktail+Depo-Medrol) and group B (cocktail alone). The outcome measures were a VisualAnalog Scale (VAS) for pain at five different time points for both THA and TKA, as well as the knee range of motion(ROM) and straight leg raise (SLR) for the TKA group only. Patients were followed for three months to observe infection,wound complications, and any venous thromboembolic event.Results: In the THA group, the preoperative VAS, 12, 24, 48, and 72h postoperative VAS were not statistically differentbetween groups A and B (P=0.49, P=0.5, P=0.96, P=0.15, and P=0.11, respectively). In the TKA group, the preoperativeVAS, 12, 24 48h, and 72h postoperative VAS were not statistically different between groups A and B (P=1.0, P=0.47,P=0.82, P=0.92, P=0.5, respectively). The mean scores of knee range of motion and ability to perform SLR were notsignificantly different between TKA patients in the steroid and non-steroid groups (P=0.18 and P=0.58, respectively).The only observed complication was one surgical site infection in the non-steroid group of the TKA.Conclusion: The obtained results did not support the benefit of including a steroid (Depo-Medrol) in the periarticularinjection cocktail for pain control after the THA and TKA.Level of evidence: II