ผลกระทบของการฉีดคอร์ติโตสเตียรอยด์เข้าข้อเข่าต่อการผ่าตัดเปลี่ยนข้อเข่าเทียม เทียบกับกลุ่มที่ไม่ได้ฉีดในโรงพยาบาลพหลพลพยุหเสนา

Jaran    Luangsa-ard

Authors

Jaran Luangsa-ard Orthopedic, Phaholpolpayuhasena Hospital, Kanchanaburi Province.

Abstract

Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intraarticular corticosteroids, there is an ongoing debate about their benefits and safety, especially perioperative and long-term post operative period, for example periprosthetic joint infection. The purpose of the study is to identify effect and complication associated with an intraarticular corticosteroid injection before total knee arthroplasty (TKA) from a single surgeon's database in patients underwent total knee arthroplasty in Paholpolpayuhasena hospital, Kanchanaburi province, Thailand.

Method We retrospectively reviewed a series of 129 patients who underwent primary TKA (Paholpolpayuhasena hospital, Kanchanaburi province, Thailand) from 1 January 2017 to 31 December 2019. In our study, the patients were divided into 2 groups: 68 patients who received an intraarticular injection before TKA and 61 patients who did not receive an injection before TKA. Demographics data, comorbidities, operative time, peri-operative blood loss and periprosthetic joint infection (PJI) were recorded. Complications and infection rate at a minimum of 12-months follow-up were compared between patients who received preoperative intraarticular corticosteroid injections and those who not received injection before TKA. The outcomes of both groups were compere using the t-test. A p value less than 0.05 are considered statistically significant.

Result Of the 129 patients in the study, patients receiving an intraarticular injection before TKA (68 patients) did not have significant difference in operative time (66.04+5.67 min) compared to non-injection group (65.72+5.42 min), p=0.15 and no significant difference in peri-operative blood loss (586.32+93.50 vs 589.02+110.08 ml) between groups, p=0.26. No periprosthetic joint infection (PJI) found in both groups after 12 months follow up.

Conclusion Our findings support the safety of intraarticular corticosteroid injections for patients with symptomatic severe osteoarthritis of knee. No significant difference in operative time, peri-operative blood loss and no increased risk of infection among patients who received steroid injections prior to the surgery was identified from the present evidence. Treatment of severe osteoarthritis of knee with intraarticular steroid injections appears to be clinically and cost effective for the relief of symptoms of the disease. A multicenter prospective study with more defined variables is needed further investigate this issue.

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