• Bernadette Lok Yiu Cheng, Eric Hang Kwong So, Grace Kit Man Hui, Boogie Pui Ki Yung, Ada Sau Kwan Tsui, Oscar Kam Fung Wang, Margaret Wai Yee Poon, Andy C M Chan, Wong Steven H S SHS Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong., Wilson Li, and Paul Sin Chuen Yip.
• Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong. cly919@ha.org.hk.
• Eur J Orthop Surg Tr. 2019 Oct 1; 29 (7): 1473-1479.

IntroductionThis study aims to investigate the effect of pre-operative intravenous methylprednisolone on post-operative pain control and joint mobility in Chinese patients undergoing single primary total knee arthroplasty.MethodsThis is a prospective, randomized, double-blinded, placebo-controlled single-centre trial. Sixty subjects were randomized into intervention and control group. The peri-operative anaesthetic and analgesic regimes were standardized. The intervention group received 125 mg methylprednisolone intravenously on the induction of anaesthesia. Subjects were assessed at 24, 30 and 48 h after surgery and upon discharge for pain scores and range of movement from the operated knee. Change in C-reactive protein level was calculated. Patient's satisfaction was recorded. Adverse reactions were documented. Subjects were followed up at 6 weeks, 4 months and 1 year.ResultsRest pain and pain on movement were significantly reduced in the methylprednisolone group at 24 and 30 h after surgery (ANOVA p = 0.030, p = 0.003, p = 0.032, p = 0.010). The methylprednisolone group demonstrated a greater range of movement from the operated knee up to 30 h after surgery (ANOVA p = 0.031). Post-operative C-reactive protein level was significantly less in the methylprednisolone group (p < 0.001). Methylprednisolone group had a higher patient's satisfaction than the control group (p < 0.01). No adverse effects were noted at the 1-year follow-up.ConclusionPre-operative intravenous methylprednisolone improves post-operative pain and joint mobility after total knee arthroplasty up to 30 h after operation. It results in a higher patients' satisfaction. It can act as an effective adjunct in the multimodal analgesic regime.Trial RegistrationClinicalTrials.gov ID: NCT03082092.

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