Effect of intravenous hydrocortisone and periarticular triamcinolone acetonide injection on quadriceps strength recovery in patients undergoing total knee arthroplasty: a prospective randomised controlled trial

BACKGROUND: Postoperative pain management is crucial for optimising recovery after total knee arthroplasty. Adequate pain control facilitates early rehabilitation, enhances quadriceps muscle recovery, improves knee function and improves patient satisfaction. Corticosteroids are widely used for postoperative pain management. However, studies comparing the efficacy of periarticular (PA) and intravenous (IV) corticosteroid injection are limited. Therefore, this study aimed to evaluate the effect of PA and IV corticosteroid injections on quadriceps strength (QS) recovery in patients undergoing total knee arthroplasty. METHODS: A total of 59 patients were included in this study. Patients were randomly assigned to two groups: the PA triamcinolone group (n = 29) and the IV hydrocortisone group (n = 30). Patients were followed up for 6 months and their QS, Visual Analogue Scale score, Modified Timed Up and Go (MTUGT) score, Western Ontario and McMaster Universities Osteoarthritis Index score, Knee Society Score and inflammatory marker levels were assessed. RESULTS: On postoperative day 3, the PA group exhibited a significantly lower reduction in QS (-43.11% ± 23.36% versus -63.7% ± 17.67%, p = 0.02) and significantly lower changes in MTUGT scores than the IV group (153.3% versus 301.3%, p < 0.01). Additionally, the knee flexion angle was significantly greater in the PA group than in the IV group on postoperative day 3 (91° ± 11° versus 82.6° ± 10.9°, p < 0.01) and at week 2 (103.2° ± 12.2° versus 97.4° ± 8.7°, p = 0.04). C-reactive protein levels were significantly lower in the PA group than in the IV group on postoperative day 1 (10.4; IQR: 5.3-17.2 versus 15.4; IQR: 9.4-28.6, p = 0.01), on day 3 (65.5; IQR: 38.3-96 versus 119.1; IQR: 69.6-146.1, p < 0.01) and at week 2 (3.9 versus 8.9, p = 0.01). On postoperative day 3, the PA group had significantly higher glucose levels than the IV group (115; IQR: 106-127 versus 106; IQR: 93-122, p = 0.02). No wound complications were observed in both groups. CONCLUSIONS: PA corticosteroid injection improves knee function in terms of muscle recovery, faster ambulation, increased knee flexion and reduced inflammation for up to 2 weeks after surgery compared with IV corticosteroid injection. A transient increase in serum glucose was observed but is unlikely to be clinically significant.