Summary

Intraosseous regional diclofenac in total knee arthroplasty shows promise by demonstrating reduced early postoperative pain and opioid consumption, alongside less impact of pain on early walking and sleeping ability, improved recovery after anaesthesia, better early knee functionality and patient satisfaction.

Abstract

Background

Postoperative pain management is paramount following primary total knee arthroplasty (TKA). Intraosseous regional administration (IORA) of antibiotics in TKA is known to result in higher local tissue concentrations. We investigated using IORA Diclofenac to improve postoperative pain management in TKA, compared to intravenous (IV) Diclofenac.

Methods

Forty-six primary TKA patients (twenty-three per group) were enrolled in a prospective double-blinded randomised controlled trial. The intervention group received 75 mg IORA Diclofenac and IV normal saline placebo. The control group received 75 mg IV Diclofenac and IO normal saline placebo. Both received standard protocol IORA Vancomycin. Pain was measured on a Visual Analogue Scale (VAS-P) until postoperative day (POD) 7. Secondary outcomes included opioid consumption, quality of recovery (QoR-15), impact of pain on walking and sleep, length of admission, patient satisfaction, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacements (KOOS,Jr), and Oxford Knee Score (OKS).

Results

Intervention group postoperative VAS-P scores (mm, [95% confidence interval]) were lower at one (21.2 [16.3, 31.4] vs 40.2 [30.8, 50.8]; p=0.007), twelve (18.2 [12.1, 25.6] vs 36.5 [27.6, 46.6]; p=0.002), twenty-four hours (21.3 [14.6, 29.2] vs 39.5 [30.2, 50] ; p= 0.003), and POD1 (23.5 [17.8, 30] vs 35.4 [28.3, 43.3]; p=0.01). The Intervention group demonstrated reduced opioid consumption from POD0-3 (p<0.01). Additionally, QoR-15 survey scores (p=0.04), POD1 walking (p=0.001) and sleeping (p=0.003), KOOS Jr scores (p=0.03) and patient satisfaction (p=0.04) at two-weeks post-surgery, were better.

Conclusion

IORA Diclofenac demonstrates enhanced early postoperative pain relief, resulting in reduced opioid consumption, better early recovery and knee function, as well as patient satisfaction.