180 patients scheduled to undergo a total knee arthroplasty were randomized to receive corticosteroid applied intravenously (n=45), peri-articularly (n=45), or both (n=45), or a placebo treatment (n=45). The primary outcome of interest was post-operative pain as measured on a Numeric Rating Scale (NRS). Functional outcomes, mobility scores, morphine consumption, quality of recovery and discharge destination were also assessed, up to 3 days post-operation. Between the 3 corticosteroid groups, no differences were observed in all outcomes in all between-group comparisons. However, patients who received the combination treatment or the intravenous treatment reported significantly more improvements over placebo, particularly with respect to pain, morphine consumption, muscle power, walking distance, and quality of recovery. The combination group showed further benefits over placebo in knee flexion, mobility scores, and home discharge rate, suggesting that a combination of peri-articular and intravenous corticosteroid may facilitate the quickest recovery vs. other administration strategies after total knee arthroplasty.