Corticosteroid-Enhanced Multimodal Cocktail Periarticular Injection in Total Knee Arthroplasty Does Not Increase Risks of Periprosthetic Joint Infection.

Abstract

The addition of corticosteroids to multimodal cocktail periarticular injections (MCPI) during total knee arthroplasty (TKA) has raised concerns about the risks of periprosthetic joint infection (PJI) despite their proven benefits. This study aimed to evaluate the impact of corticosteroid-enhanced multimodal cocktail periarticular injections (MCPI-S) on the incidence of PJI in patients undergoing TKA. A retrospective cohort study was conducted using a longitudinally maintained institutional database, including 20,382 patients who underwent primary TKA between 2000 and 2018. Patients were divided into two groups: those receiving MCPI-S containing triamcinolone acetate and those receiving MCPI without corticosteroids. There were 10,094 patients who received MCPI, while 10,288 received MCPI-S during TKA. The primary outcome was the incidence of PJI within two years postoperatively. Statistical comparisons were performed using Mann-Whitney U and Pearson's Chi-square tests, with significance set at P < 0.05. The overall incidence of PJI was 0.4% (89 cases). The MCPI group had a PJI rate of 0.5% (51 cases) compared to 0.4% (38 cases) in the MCPI-S group (P = 0.14). The types of surgical interventions that required to manage PJI were similar between the groups (P = 0.43). There were no significant differences observed in demographic variables, except for a median age difference of 0.4 years, which was not clinically relevant. The addition of corticosteroids, specifically triamcinolone acetate, to MCPI during TKA does not increase the risk of PJI. These findings provide strong evidence supporting the safety and efficacy of MCPI-S as part of a multimodal pain management strategy, offering reassurance for its routine use in clinical practice to enhance postoperative recovery. III.