Adding hormone in cocktail promotes rapid recovery after unicompartmental knee arthroplasty

doi:10.3969/j.issn.2095-4344.2757

Abstract

Abstract:

BACKGROUND: Postoperative pain is a common clinical problem in unicompartmental knee arthroplasty, and severe pain can affect postoperative efficacy. Hormone is a common and effective anti-inflammatory drug, and there is some controversy over whether to add hormone to the local injection of cocktail in unicompartmental knee arthroplasty.

OBJECTIVE: To evaluate the effectiveness of adding hormones to the cocktail to promote rapid recovery after unicompartmental knee arthroplasty.

METHODS: Osteoarthritis patients receiving unilateral unicompartmental knee arthroplasty from October 2017 to March 2019 were randomly divided into a hormone group (local injection of cocktail + 40 mg triamcinolone acetonide) and a control group (local injection of cocktail + equivalent normal saline). Visual analogue scale score, fentanyl consumption, knee function, inflammatory indicators, adverse reactions and complications were observed in both groups after surgery.

RESULTS AND CONCLUSION: (1) Finally, 80 patients were included in the study (n=40 in each group). There was comparability between the two groups (P > 0.05). (2) The static and dynamic visual analogue scale scores of patients in the hormone group at 1, 2 and 3 days after surgery were significantly lower than those in the control group (P < 0.05). (3) The dosage of fentanyl in the hormone group was significantly lower than that in the control group at 48 hours after surgery (P < 0.05). (4) At 1, 3, 5 days and 3 months after surgery, the knee flexion range of motion in the hormone group was higher than that of the control group (P < 0.05). (5) Hospital for Special Surgery score of knee in the hormone group was higher than that in the control group at 3 months after surgery (P < 0.05). There was no statistically significant difference in Hospital for Special Surgery scores of the knee between two groups at 6 months after surgery (P > 0.05). (6) C-reactive protein levels at 3 days and interleukin-6 levels at 24 hours after surgery in the hormone group were significantly lower than those in the control group (P < 0.05). (7) The incidence of complications in the hormone group was significantly lower than that in the control group (P < 0.05). (8) Addition of hormones in the cocktail can effectively promote the rapid recovery after unicompartmental knee arthroplasty.

Key words: triamcinolone acetonide, cocktail, rapid recovery, fentanyl, range of motion, unicompartmental knee arthroplasty, osteoarthritis, multimodal

CLC Number:

Yue Ju’an, Zhang Qidong, Huang Cheng, Guo Wanshou, Wang Weiguo, Wang Randong. Adding hormone in cocktail promotes rapid recovery after unicompartmental knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(27): 4343-4348.

Figures/Tables 7

References

[1] PRICE AJ, SVARD U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2011;469(1):174-179.

[2] NOTICEWALA MS, GELLER JA, LEE JH, et al. Unicompartmental knee arthroplasty relieves pain and improves function more than total knee arthroplasty. J Arthroplasty. 2012;27(8 Suppl):99-105.

[3] PANDIT H, JENKINS C, GILL HS, et al. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br. 2011;93(2):198-204.

[4] PINSORNSAK P, NANGNUAL S, BOONTANAPIBUL K. Multimodal infiltration of local anaesthetic in total knee arthroplasty; is posterior capsular infiltration worth the risk? a prospective, double-blind, randomised controlled trial. Bone Joint J. 2017;99-B(4):483-488.

[5] ANDERSEN KV, NIKOLAJSEN L, HARALDSTED V, et al. Local infiltration analgesia for total knee arthroplasty: should ketorolac be added?. Br J Anaesth. 2013;111(2):242-248.

[6] 赵学千,贾育松,孙旗,等.关节镜清理联合术后针刺与鸡尾酒疗法治疗膝骨关节炎[J].中华关节外科杂志(电子版),2018,12(5):681-686.

[7] 李国庆,王添兴,莫和塔尔·莫敏,等.全膝关节置换多模式镇痛:吗啡与鸡尾酒镇痛的疗效对比[J].中国组织工程研究,2018,22(27):4265-4270.

[8] 白斌.经皮穴位电刺激联合“鸡尾酒”疗法对全膝关节置换术后疼痛控制的临床研究[D]. 济南:山东中医药大学,2018.

[9] 余振阳.“鸡尾酒”配方药物与氨甲环酸联合应用于单侧膝关节置换术[D]. 北京:中国人民解放军总医院,解放军医学院,解放军总医院,军医进修学院, 2017.

[10] 何智超.氨甲环酸与镇痛鸡尾酒在全膝关节置换术中局部联合应用的研究[D]. 重庆:第三军医大学,中国人民解放军陆军军医大学, 2017.

[11] LIU P, GUO WS, ZHANG QD, et al. Efficacy and safety of compound betamethasone cocktail therapy in primary unilateral unicompartmental knee arthroplasty. Zhonghua Yi Xue Za Zhi. 2019;99(39):3100-3104.

[12] FAN Z, MA J, KUANG M, et al. The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty: A systematic review and meta-analysis. Int J Surg. 2018;52:149-155.

[13] KIM JI, KIM YT, JUNG HJ, et al. Does adding corticosteroids to periarticular injection affect the postoperative acute phase response after total knee arthroplasty? Knee. 2019. pii: S0968-0160(19)30255-8.

[14] 郭万首.单髁关节置换的病例选择[J].中华关节外科杂志(电子版), 2015, 9(3):377-379.

[15] SHI ZB, DANG XQ. Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection and nonsteroidal anti-inflammatory drug use in total knee arthroplasty. Niger J Clin Pract. 2018;21(9): 1221-1227.

[16] PANG HN, LO NN, YANG KY, et al. Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up. J Bone Joint Surg Br. 2008;90(6):738-744.

[17] BRAVIN LN, ERNEST EP, DIETZ MJ, et al. Liposomal bupivacaine offers no benefit over ropivacaine for multimodal periarticular injection in total knee arthroplasty. Orthopedics. 2019:1-6.

[18] FISCHER HB, SIMANSKI CJ. A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia. 2005;60(12):1189-1202.

[19] TRUONG A, MUJUKIAN A, FLESHNER P, et al. No pain, more gain: reduced postoperative opioid consumption with a standardized opioid-sparing multimodal analgesia protocol in opioid-tolerant patients undergoing colorectal surgery. Am Surg. 2019;85(10):1155-1158.

[20] SCHNEIDER J, BROOME B, KEELEY D. Narcotic-free perioperative total knee arthroplasty: does the periarticular injection medication make a difference? J Knee Surg. 2019. doi: 10.1055/s-0039-1696975.

[21] LAKRA A, GROSSO M, JENNINGS EL, et al. Improved pain control with adductor canal block using liposomal bupivacaine after total knee replacement: a retrospective cohort study. Arthroplast Today. 2019; 5(3):325-328.

[22] TOFTDAHL K, NIKOLAJSEN L, HARALDSTED V, et al. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop. 2007;78(2):172-179.

[23] FAN JC. Intra-operative periarticular multimodal injection in total knee arthroplasty: a local hospital experience in Hong Kong. Hong Kong Med J. 2018;24(2):145-151.

[24] MULLAJI A, KANNA R, SHETTY GM, et al. Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty:a prospective, randomized trial. J Arthroplasty. 2010; 25(6):851-857.

[25] MAHESHWARI AV, BLUM YC, SHEKHAR L, et al. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res. 2009;467(6):1418-1423.

[26] LAMPLOT JD, WAGNER ER, MANNING DW. Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29(2):329-334.

[27] WU JW, WONG YC. Elective unilateral total knee replacement using continuous femoral nerve blockade versus conventional patient-controlled analgesia: perioperative patient management based on a multidisciplinary pathway. Hong Kong Med J. 2014;20(1):45-51.

[28] YAYAC M, LI WT, ONG AC, et al. The Efficacy of Liposomal Bupivacaine Over Traditional Local Anesthetics in Periarticular Infiltration and Regional Anesthesia During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34(9):2166-2183.

[29] AFFAS F, NYGÅRDS EB, STILLER CO, et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 2011;82(4):441-447.

[30] SPANGEHL MJ, CLARKE HD, HENTZ JG, et al. The Chitranjan Ranawat Award: Periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res. 2015;473(1):45-53.

[31] HYLAND SJ, DELIBERATO DG, FADA RA, et al. Liposomal bupivacaine versus standard periarticular injection in total knee arthroplasty with regional anesthesia: a prospective randomized controlled trial. J Arthroplasty. 2019;34(3):488-494.

[32] VENDITTOLI PA, MAKINEN P, DROLET P, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am. 2006;88(2):282-289.

[33] LAORUENGTHANA A, JARUSRIWANNA A, RATTANAPRICHAVEJ P, et al. Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial. BMC Musculoskelet Disord. 2019;20(1):162.

[34] RASMUSSEN S, KRAMHØFT MU, SPERLING KP, et al. Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients. Acta Orthop Scand. 2004;75(5):606-609.

[35] HOSHIKAWA N, SAKAI A, TAKAI S, et al. Targeting Extracellular miR-21-TLR7 Signaling Provides Long-Lasting Analgesia in Osteoarthritis. Mol Ther Nucleic Acids. 2019;19:199-207.

[36] MEHTA S, AKHTAR S, PORTER RM, et al. Interleukin-1 receptor antagonist (IL-1Ra) is more effective in suppressing cytokine-induced catabolism in cartilage-synovium co-culture than in cartilage monoculture. Arthritis Res Ther. 2019;21(1):238.

[37] LEE JH, WANG SI, NOH SJ, et al. Osteonecrosis of the medial tibial plateau after intra-articular corticosteroid injection: A case report. Medicine (Baltimore). 2019;98(44):e17248.

[38] CHRISTENSEN CP, JACOBS CA, JENNINGS HR. Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial. J Bone Joint Surg Am. 2009;91(11): 2550-2555.

[39] ARMSTRONG RW, BOLDING F, JOSEPH R. Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy. 1992;8(2):213-223.

[40] GRAY RG, GOTTLIEB NL. Intra-articular corticosteroids. An updated assessment. Clin Orthop Relat Res. 1983;(177):235-263.

[41] FITZGERALD RH. Intrasynovial injection of steroids uses and abuses. Mayo Clin Proc. 1976;51(10):655-659.

[42] LAZAREVIC MB, SKOSEY JL, DJORDJEVIC-DENIC G, et al. Reduction of cortisol levels after single intra-articular and intramuscular steroid injection. Am J Med. 1995;99(4):370-373.

[43] ANKAY YA, AKCA B, BUYUKAKKUS B, et al. Procaine and saline have similar effects on articular cartilage and synovium in rat knee. BMC Anesthesiol. 2018;18(1):51.

[44] ZLOTNICKI JP, HAMLIN BR, PLAKSEYCHUK AY, et al. Liposomal Bupivacaine vs Plain Bupivacaine in Periarticular Injection for Control of Pain and Early Motion in Total Knee Arthroplasty: A Randomized, Prospective Study. J Arthroplasty. 2018;33(8):2460-2464.

[45] 彭慧明,唐杞衡,钱文伟,等.膝关节周围注射镇痛在全膝关节置换术后多模式镇痛方案中的作用[J].中华骨科杂志,2016,36(7):406-412.

[46] HUIMING P, QIHENG T, WENWEI Q, et al.A randomized controlled trial on additional efficacy of local anesthetic injection on multimodal analgesia in total knee arthroplasty. Chin J Orthop. 2016;(7):406-412.

[47] ALLEN GC, ST AMA, LUI AC, et al. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial. Anesthesiology. 1993;79(3):475-480.

[48] TANAKA N, SAKAHASHI H, SATO E, et al. The efficacy of intra-articular analgesia after total knee arthroplasty in patients with rheumatoid arthritis and in patients with osteoarthritis. J Arthroplasty. 2001;16(3):306-311.

[49] HIRASAWA N, KUROSAKA K, NISHINO M, et al. No clinically important difference in pain scores after tha between periarticular analgesic injection and placebo: a randomized trial. Clin Orthop Relat Res. 2018;476(9):1837-1845.

[50] SVIRSKIS D, MARTIS W, BHUSAL P, et al. Analysis of the postoperative periarticular environment and influence on sustained drug delivery from a gel formulation. J Pharm Sci. 2018;107(9): 2399-2403.