Page 59 - Ebook-Book JCMS 2025

The Effect of Intravenous Corticosteroid and Periarticular
Corticosteroid Injection on the Quadriceps Power Recovery in
Total Knee Replacement Patient; a Prospective Randomized
Controlled Trial
Kulapat Chulsomlee1, Sorawut Thamyongkit1
, Chattrapat Asavakunalai2, Thitiphol Wanitchanont1*
1 Chakri Naruebodindra Medical Institute
2 Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
*Corresponding Author E-mail: thitiphol.wan@mahidol.ac.th
Background: Abstract
Post-operative pain management is essential for optimizing recovery following total
knee arthroplasty (TKA). Adequate pain control facilitates early rehabilitation, enhances
quadriceps muscle recovery, improves knee function, and increases patient satisfaction.
Corticosteroids have been widely utilized to alleviate post-operative pain. However, there
is limited research comparing the efficacy of peri-articular (PA) and intravenous (IV)
corticosteroid injections.
Methods: Patients were randomly assigned to the PA group (n =30) and IV group (n = 30). Quadriceps
muscle strength (QS), visual-analog-pain-scale(VAS), modified-timed-up-and-go (MTUGT),
Western-Ontario-and McMasters-Universities-Osteoarthritis-Index[WOMAC], Knee-Society-
Score[KSS] and inflammatory marker were followed for 6 months.
Results: The reduction in QS from pre-operative levels was significantly lower in the PA group on
postoperative day 3 (-43.1% vs. -63.7%; p < 0.01) and at two weeks (-30.9% vs. -46.29%; p
= 0.04). The change in the MTUGT was significantly lower in the PA group on postoperative
day 3 (153.3% vs. 301.3%; p < 0.01). Additionally, the knee flexion angle was significantly
greater in the PA group on postoperative day 3 (103.2° ± 12.2° vs. 91° ± 11.3°; p < 0.01) and
at two weeks (103° ± 12.1° vs. 97.4° ± 8.7° ; p = 0.03). The C-reactive protein (CRP) level
was significantly lower in the PA group on postoperative day 1 (10.4 vs. 15.4; p = 0.01), day
3 (65.5 vs. 119.1; p < 0.01), and at two weeks (3.9 vs. 8.9; p = 0.01). The glucose level at day
3 was significantly higher in the PA group (115±106 VS 106±93, p-value 0.01). No wound
complications were found in either group.
Conclusion: PA corticosteroid injection improves knee function in muscle recovery, faster ambulation,
increased knee flexion, and reduced inflammation for up to two weeks post-operation
compared to IV corticosteroids. However, serum glucose levels should be monitored.
Harmony in health: Innovation for Sustainable Medicine
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