Perbandingan Luaran Fungsi Klinis Pasien yang Diinjeksi Periartikular Cocktail Intraoperasi dengan yang Tidak Diinjeksi pada Pasien Osteoarthritis Lutut Derajat Berat yang Menjalani Operasi Penggantian Sendi Lutut di Medan

Abstract

Introduction: Total Knee Arthroplasty(TKA) are often performed in severe osteoarthritis when conservative treatment fail to improve the patient's condition. Post-TKA pain is one of the most commonly reported complications by patients and progressively more severe due to soft tissue damage that causes inflammation and triggers the release of inflammatory mediators. In knee OA surgery, it is important to evaluate postoperative pain and knee function. The optimal approach is possible with local intra-articular or peri-articular injections in combination with analgesics. Early recovery of knee function in patients after total knee arthroplasty has been reported to accelerate mobilization and reduce morbidity. Methods :This study used a retrospective cohort study design conducted at H. Adam Malik General Hospital, Medan. The total sample includes 48 people with an average age of 64 years. All samples were patients diagnosed with osteoarthritis undergoing unilateral primary total knee arthroplasty. The samples were divided into two groups, a control group and an intervention group which were injected with a periarticular cocktail containing a mixture of ropivacaine HCl 7.5 mg, methylprednisolone 125 mg and saline. Clinical function was assessed in both groups using the Visual Analogue Scale (VAS) 12,24,48,72 hour post operative, Oxford Knee Score (OKS) 28 day post operative, Knee joint range of motion (ROM) 1,2,3 and 21 day post operative and Hollander Wound Evaluation Score (HWES). Results :The mean value of VAS in the control and intervention groups were 3.63 ± 0.57 and 0.5 ± 0.51 at 12 hours postoperatively; 3.63 ± 0.49 and 0.67 ± 0.48 at 24 hours postoperatively; 2.71 ± 0.85 and 1.17 ± 0.48 at 48 hours postoperatively; 2,71±0,55 and 1,17±0,48 at 72 hours postoperatively. The mean ROM values in the control and intervention groups were 10 ± 9.1 and 38.25 ± 10.16 on 1st postoperative day; 41.79 ± 10.77 and 62.83 ± 7.19 on 2nd postoperative days; 80.46 ± 9.93 and 83.54 ± 9.80 at 3rd postoperative days; 106,21±12,9 and 115,88±5,310 at 21st postoperative days. The OKS values on the 28th postoperative day were 34.33 ± 4.22 and 34.92 ± 4.10 in the control and intervention groups. The HWES Score values on 4 week post operation were 5,88±0,35 and 5,92±0,28. Discussion :In this study, postoperative pain scales (VAS) were significantly reduced (p<0.001) at 12, 24,and 48 hours post operative in the group receiving cocktail injections compared to the control group, indicating that the first 2-day postoperative range of motion (ROM) grade. This demonstrates that the use of periarticular cocktail injections in total knee arthroplasty (TKA) surgery has a positive impact on early mobilization in patients after TKA surgery.