ARTHROPLASTY
Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial
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これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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)
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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