Efficacy of corticosteroids addition to multimodal cocktail periarticular injection in total knee arthroplasty with hemophilic arthropathy

Abstract

Hemophilic arthropathy (HA) patients frequently have perioperative pain after total knee arthroplasty (TKA). Although periarticular local infiltration analgesia by using a cocktail has been utilized in various surgeries, the efficacy of cocktail administration in HA patients undergoing TKA remains unclear. This study aims to determine whether cocktail therapy can relieve perioperative pain and improve postoperative rehabilitation activities after TKA in HA patients, and whether the addition of corticosteroids to the cocktail is both effective and necessary. We conducted a retrospective analysis of clinical data from 98 HA patients who underwent TKA at our institution between January 2015 and January 2024. All surgeries were performed by two senior orthopedic surgeons and two assistants from our team, using posterior-stabilized prostheses. The patients were divided into two groups: the experimental group (ropivacaine 100 mg + morphine 10 mg + dexamethasone 35 mg + normal saline 50 ml, n = 45) and the control group (ropivacaine 100 mg + morphine 10 mg + normal saline 50 ml, n = 53). A three-month follow-up study was conducted to compare the postoperative outcomes in the above groups, including Visual Analogue Scale (VAS) scores, knee range of motion (ROM), Knee Society Score (KSS), inflammatory markers (C-reactive protein, CRP, and Interleukin- 6, IL- 6), and hospitalization parameters (body temperature, length of hospital stay, hospitalization costs, and perioperative usage of coagulation factor VIII). Both groups improved knee joint function and reduced post-operative pain at the last follow-up. With knee ROM increasing from 47.22° to 95.36° and KSS increasing from 35.42 to 82.02, the experimental group's VAS ratings dropped from 4.31 to 1.47. Besides, the control group's VAS scores dropped from 4.71 to 2.09, knee ROM increased from 45.95° to 91.60°, and KSS from 36.87 to 80.40 (all with P < 0.05). Throughout the follow-up, the experimental group showed better pain reduction (P < 0.05), with greater knee ROM and KSS within the first month compared to the control group. This difference diminished by the third month, but the experimental group still showed higher knee ROM and KSS. Additionally, the experimental group exhibited lower inflammation markers and a shorter hospital stay (P < 0.05). In people with hemophilia undergoing TKA the cocktail of ropivacaine 100 mg + morphine 10 mg + nomal saline 50 mL + 35 mg dexamethasone seemed to be more effective in relieving postoperative pain than the cocktail of ropivacaine 100 mg + morphine 10 mg + nomal saline 50 mL at 3-month follow-up.

Keywords: Cocktail; Corticosteroids; Hemophilia; Pain; Total knee arthroplasty.

Fig. 1

Preoperative X-ray of the patient’s knee. The X-rays of the patient showed Kellgren-Lawrence grading stages 4, which showed narrowing of the joint space, the formation of a large number of bony encumbrances, and joint deformity. a: Preoperative anteroposterior radiograph. b: Preoperative lateral view. c: postoperative anteroposterior radiograph. d: postoperative lateral radiograph. e: final follow-up anteroposterior radiograph. f: final follow-up lateral radiograph.

Fig. 2

Pain Score. Pre-op: preoperative; POD: postoperative day; POM: postoperative month. *: P < 0.05.

Fig. 3

ROM of knee joint and Joint Function Score. Pre-op: preoperative; POD: postoperative day; POM: postoperative month. *: P < 0.05.