Preventive intra-articular corticosteroid use for postoperative synovitis in high-risk patients: influence on clinical and functional outcomes

Post-arthroscopic prolonged synovitis is a significant problem. Using the predictor assessment, it is possible to select measures and prevent the development of this rather common complication. The purpose was a comparative assessment of the clinical and functional results of early postoperative intra-articular administration of glucocorticosteroids (GCS) in patients with a high risk of chronic synovitis. Material and methods. The study included 350 patients with osteoarthritis (OA) of various etiologies and meniscus injuries, of whom 54 were identified as having a high risk of long-term postoperative synovitis. Of these, 48 patients with knee synovitis that persisted two weeks after knee arthroscopy were randomized into two groups: standard anti-inflammatory treatment and similar therapy with early prophylactic intra-articular administration of GCS (14–21 days after the intervention). Results. There was a significant improvement in the indices of all functional scales with significantly more pronounced changes by the third month in the main group: KOOS pain subscale (78.5 ± 1.97 vs. 72.8 ± 2.27), symptoms (79.7 ± 1.52 vs. 69.8 ± 3.01), Lysholm index (83.6 ± 1.9 vs. 74.8 ± 2.54), and IKDC (70.8 ± 2.02 vs. 64.6 ± 2.2). The frequency of achieving PASS was higher in the group with GCS early administration according to KOOS pain, KOOS symptoms, Lequesne index, and IKDC. According to a number of publications, postoperative intra-articular administration of GCS is considered risky in terms of infection. Chronic postoperative synovitis is an equally serious and much more common problem in arthroscopy. The possibility of preventive injection therapy in patients with identified predictors of synovitis may increase the treatment effectiveness. The early use of GCS significantly reduced the duration of synovitis, accelerated functional recovery and improved treatment results according to such scales as KOOS, Lysholm, Lequesne and IKDC, without increasing the risk of side effects. Conclusion. Intra-articular administration of GCS at 14-21 days after arthroscopy is safe. The procedure significantly reduces the persistence and duration of synovitis and accelerates functional recovery.