Periarticular Group Research Articles

Comparison of effectiveness of intraoperative subperiosteal versus periarticular analgesic cocktail injection for post operative analgesia in patients undergoing total knee arthroplasty

Background: Early postoperative pain management is pivotal in patients undergoing Total knee arthroplasty. The advantage of Local infiltration analgesia is its ability to provide control of pain without interfering with motor strength of the lower extremity, thereby allowing early mobilization of patients. This study compares the effectiveness of local analgesic cocktail injection given through subperiosteal vs. periarticular routes. Methods: The study included 30 patients admitted for primary total knee arthroplasty. They were grouped into two groups based on different injection sites. Group A included patients who received subperiosteal injection and Group B included patients who received periarticular injection, under spinal anaesthesia. The difference in pain among the two groups, using VAS at 12, 24, 48, and 72 hrs postoperatively, postoperative range of movements, and Functional outcome using IKDC score at the end of 6 months were assessed and compared between the two groups. Results: The mean VAS scores at 12, 24, 48, and 72 hrs were 0.87±0.35, 1.47±0.52, 1.80±0.41, 1.07±0.46 in subperiosteal group and 2.00±0.53, 2.47±0.52, 2.80±0.56, 1.93±0.59 in periarticular group. The 6 months postoperative IKDC scores were 51.34±0.41 and 51.04±0.61 respectively. Conclusions: Subperiosteal cocktail injection can significantly reduce the postoperative pain and result in early recovery of range of movements, compared with periarticular cocktail injection in patients undergoing Total knee arthroplasty. But the long-term functional outcomes were comparable among both the groups.

Comparison of ultrasound-guided genicular nerve block and knee periarticular infiltration for postoperative pain and functional outcomes in knee arthroplasty - A randomised trial.

Optimal analgesia after total knee arthroplasty (TKA) enhances patients' and surgical outcomes. The study investigated the ultrasound-guided genicular nerve block versus the periarticular infiltration in TKA. Eighty-eight patients aged above 50 years scheduled for unilateral TKA were randomised as: Group 1 received intraoperative periarticular infiltration (0.5 mL adrenaline [4.5 µg/mL], 20 mL bupivacaine 0.5% with 89.5 mL saline) and Group 2 received immediate postoperative genicular nerve block (15 mL bupivacaine 0.25% with 2.5 g/mL adrenaline). The postoperative morphine consumption was during the first two postoperative days the primary outcome. The secondary outcomes were time to rescue analgesia, pain scores and functional outcomes. The comparison between groups was performed using the Chi-square test, the Student's t-test and the Mann-Whitney U test, as appropriate. The postoperative morphine consumption during the first two postoperative days and pain scores at rest at 12 h postoperatively were less in Group 1 than in Group 2 (P < 0.001). Pain scores during movement on the first postoperative day were lower in the periarticular group than the genicular group at 6, 12 and 24 h (P < 0.001). At 18 h, pain scores were higher in the periarticular group than in the genicular group at rest and movement (P < 0.001). Quadriceps motor strength scores were comparable between groups (P > 0.05). The knee range of motion and time up and go test during both days showed a statistically significant difference in the periarticular group compared to the genicular group (P < 0.05). Periarticular infiltration and genicular nerve block yield effective postoperative analgesia and functional outcomes after TKA without motor affection.

Comparison of the Effect of Intra-Articular, Periarticular, and Combined Injection of Analgesic on Pain Following Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial.

Background:The aim of this study was to compare the efficacy of 3 methods of intraoperative analgesic cocktail injection during total knee arthroplasty (TKA)—intra-articular (IA), periarticular (PA), and combined intra-articular and periarticular (IA+PA)—on controlling early postoperative pain.Methods:This was a prospective double-blinded parallel randomized clinical trial. A total of 153 patients scheduled for TKA were allocated to IA, PA, or IA+PA (51 patients each) by block randomization. The primary outcome was morphine consumption. Secondary outcomes were visual analogue scale (VAS) pain, knee flexion, straight leg raising, Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results:The morphine consumption was lowest in the PA group (median = 0, interquartile range [IQR] = 5) and highest in the IA group (median = 10, IQR = 5). The PA group had significantly lower VAS pain at rest than either IA (mean difference = −0.70; 95% confidence interval [CI] = −0.93 to −0.46; p < 0.001) or PA+IA (mean difference = −0.41; 95% CI = −0.65 to −0.18; p < 0.001). The PA group had also lower VAS pain during activity compared with IA (mean difference = −0.63; 95% CI = −0.85 to −0.40; p < 0.001) and IA+PA (mean difference = −0.38; 95% CI = −0.61 to −0.16; p < 0.001). The PA group had significantly greater active knee flexion compared with IA (mean difference = 9.68°; 95% CI = 5.50° to 13.86°; p < 0.001) and IA+PA (mean difference = 5.13°; 95% CI = 0.95° to 9.31°; p = 0.010). Passive knee flexion was greater for PA than IA (mean difference = 7.85°; 95% CI = 4.25° to 11.44°; p < 0.001). Other outcome variables were not significantly different among the 3 groups. The only complications were wound drainage (1 each in the IA and IA+PA groups) and deep venous thrombosis (1 in the IA group).Conclusions:PA was associated with less early postoperative pain and greater active knee flexion compared with the other 2 analgesic methods.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Do bicortical diaphyseal array pins create the risk of periprosthetic fracture in robotic-assisted knee arthroplasties?

BackgroundOptical array placement for robotic-assisted knee replacement introduces the rare, but real risk of periprosthetic fracture. The purpose of this retrospective study was to review the incidence of fracture with the conventional technique of bicortical diaphyseal pin placement. We also evaluated a modified method of unicortical periarticular pin placement to mitigate this risk.MethodsWe reviewed 2603 knee arthroplasties that were performed between June 2017 and December 2019. The conventional bicortical diaphyseal technique was used in 1571 knees (bicortical diaphyseal group) and the unicortical periarticular technique was used in 1032 knees (unicortical periarticular group).ResultsA more than 1-year follow-up revealed that 3 femoral shaft fractures (0.19%) occurred in the bicortical diaphyseal group and no fracture took place in the unicortical periarticular group. There was no array loosening in either group.ConclusionsThe modified unicortical periarticular pin placement is a reliable technique for computer-navigated and robotic-assisted knee arthroplasties. It may be associated with a lower incidence of postoperative femoral shaft fractures, compared to conventional bicortical diaphyseal pinning.

Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis.

BackgroundOsteoarthritis (OA) is a degenerative disease that can lead to painful and dysfunctional joints. Prolotherapy involves using injections to produce functional restoration of the soft tissues of the joint. Intra-articular injections are controversial because of the introduction of needles into the articular capsule.ObjectivesTo compare the effect of periarticular versus intra-articular prolotherapy on pain and disability in patients with knee OA.Study designRandomized double-blind controlled clinical trial.SettingSingle center, university hospital (Imam Hossein Hospital, Tehran, Iran).MethodsA total of 104 patients with chronic knee OA were enrolled. In the intra-articular group, 8 mL of 10% dextrose and 2 mL of 2% lidocaine were injected. Injections were repeated at 1 and 2 weeks after the first injection. In the periarticular group, 5 mL of 20% dextrose and 5 mL of 1% lidocaine were injected subcutaneously at 4 points in the periarticular area. Pain and disability, as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were recorded at each follow-up visit at 1, 2, 3, 4, and 5 months post-injection.ResultsThe visual analog scale score was significantly lower in the periarticular compared with the intra-articular group at the 2-, 3-, 4-, and 5-month visits but not at 1 month. Morning stiffness and difficulty in rising from sitting were improved in both groups and were not signifi-cantly different in the peri- and intra-articular groups. Pain, joint locking, and limitation scores were all improved in both groups. Difficulty in walking on flat surfaces or climbing stairs, and sitting and standing pain, were all improved in both groups from 1 to 5 months after treatment.LimitationsWOMAC scores are subjective and could be a limitation of the study.ConclusionPeriarticular prolotherapy has comparable effects on pain and disability due to knee OA to intra-articular injections, while avoiding risks of complications.

Intra-Articular Versus Periarticular Acromioclavicular Joint Injection: A Multicenter, Prospective, Randomized, Controlled Trial

The purpose of this randomized study was to compare the clinical efficacy of intra-articular versus periarticular acromioclavicular joint injections. In this multicenter, prospective, randomized, controlled trial, 101 patients (106 shoulders) with symptomatic acromioclavicular joints were treated with an injection and were randomly assigned to either the intra-articular group or the periarticular group. To ensure accurate needle placement either intra-articularly or in a periarticular manner, the needle was placed under ultrasound guidance. Baseline values including the Constant-Murley score, pain assessment with a visual analog scale for pain under local pressure and pain at night, and the crossover arm test were investigated in 7 different centers immediately before treatment. Follow-up examinations were scheduled after 1 hour, 1 week, and 3 weeks. All patients completed the study. Overall, a highly significant clinical improvement in all tested variables and in both groups was observed over time (P < .0001) beginning with 1 hour after treatment and lasting for the entire follow-up period of 3 weeks. The difference between the 2 groups was not significant except regarding the crossover arm test (P < .016). With both injection techniques, a highly significant clinical advantage for the patient can be achieved. The difference between the 2 treatments was not significant except for more pain reduction according to the crossover arm test after intra-articular injection at 3 weeks' follow-up. Level II, multicenter, randomized, prospective, controlled trial.