TKA: Intraoperative corticosteroid injections reduce hospital stay length .
Este estudio ha sido identificado como potencialmente de alto impacto.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(1):8 J Bone Joint Surg Am. 2009 Nov;91(11):2550-5.Seventy-six patients undergoing total knee arthroplasty were randomized to receive an intraoperative multi-modal periarticular injection with or without a corticosteroid. Patients who received the corticosteroid had significantly shorter hospital stays. No significant group differences in pain scores, narcotic consumption, outcome scores, or motion were identified up to 12 weeks post-surgery.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
4/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Adequate analgesia is an important aspect in the rehabilitation process following total knee arthroplasty. Intraoperative multi-modal analgesic injections have been demonstrated to decrease postoperative pain and improve early clinical outcomes. Corticosteroids are often a part of these multi-modal injections; however, currently no trials have specifically assessed the efficacy of corticosteroid inclusion in improving early postoperative outcomes.
¿Cuál era la pregunta principal de la investigación?
Does an intraoperative periarticular corticosteroid injection reduce pain and improve functional outcomes of patients undergoing total knee arthroplasty compared to those undergoing a similar injection without the steroid?
- There were no differences in mean narcotic consumption, pain scores on the first post operative day, or pain scores on the day of discharge (p>0.05)
- The corticosteroid group had a significantly shorter mean hospital stay of 2.6 +/- 0.7 days compared to 3.5 +/- 1.9 days for patients in the no-steroid group (p=0.01)
- Both groups demonstrated significant improvements in knee range of motion and Knee Society knee and function scores from preoperative measures (p<0.05); however, there were no differences between the two treatment groups
- No complications were noted in the no-steroid group and 3 (including 1 infection) were observed in the steroid group; this difference was not significant (p=0.24)
¿Qué es lo que más debo recordar?
The addition of a corticosteroid to an intraoperative periarticular multi-modal injection did not improve pain relief, motion, or function in the early postoperative period. However, the steroid injection reduced the hospital stay of patients undergoing total knee arthroplasty compared to the control.
¿Cómo afectará esto al cuidado de mis pacientes?
The use of a corticosteroid as an adjunct to multi-modal intraoperative injections may result in shorter hospital stays, but will have no effect on postoperative pain, range of motion, or function. Further research is needed to confirm these results and determine if there are differences in complications attributed to the addition of corticosteroid.
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