JOA - 2026-04-20 - Journal Article
Periarticular Injection for Pain Control after Surgical Treatment of Knee Periprosthetic Joint Infection.
Shultz GA, Williams AM, Ozdemir LA, Siegel ER, Barnes CL, Mears SC, Stronach BM, Stambough JB
Topics
Key Takeaway
Periarticular injection during knee PJI surgery reduced 24-hour opioid consumption by 40.2 MME (90.2 vs 130.4, p=0.004) without increasing 12-month reinfection rates (5.0% vs 8.0%, p=0.30).
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Summary
This study asked whether intraoperative PAI is safe and effective for pain control in surgical treatment of knee PJI, comparing 121 PAI recipients to 188 controls across DAIR and staged revision procedures from 2015–2023. PAI reduced pain scores at 24 hours (5.53 vs 5.71, p<0.001) and 48 hours (5.35 vs 5.64, p=0.042), and cut 24-hour MME consumption by 31% (90.2 vs 130.4, p=0.004). Reinfection at 12 months was not significantly different between groups (5.0% vs 8.0%, p=0.30).
Key Limitation
The retrospective design cannot exclude selection bias in PAI administration (surgeons may have preferentially used PAI in healthier, less complex cases), which could confound both the efficacy and the reinfection safety findings.
Original Abstract
BACKGROUND
Periprosthetic joint infection (PJI) is a serious complication after total knee arthroplasty (TKA), and treatment often requires extensive surgery. Intraoperative periarticular injection (PAI) of local anesthetic is commonly used during primary TKA to improve postoperative pain control, but it is not typically used for infection-related procedures due to fears of spreading infection. This study evaluated the safety and efficacy of the use of PAI in the treatment of knee PJI.
METHODS
We performed a retrospective review of 309 patients who underwent surgical treatment of knee PJI between 2015 and 2023. Intraoperative PAI was administered to 121 patients, while 188 did not receive PAI and served as controls. Postoperative pain scores and opioid consumption (morphine milligram equivalents, MME) were recorded at 24, 48, and 72 hours, and reinfection rates were assessed at one year post-surgery.
RESULTS
There were no significant differences in reinfection rates at 12 months (5.0% with PAI versus 8.0% without, P = 0.30). The PAI group reported decreased pain scores compared to the non-PAI group at the 24-hour (5.53 versus 5.71, P < 0.001) and 48-hour marks (5.35 versus 5.64, P = 0.042). Patients who received PAI also required significantly less average MMEs in the first 24 hours after surgery compared to the non-PAI group (90.2 versus 130.4 MME, P = 0.0036).
CONCLUSION
Intraoperative PAI during surgical treatment for knee PJI reduced early postoperative opioid requirements and patient-reported pain levels without increasing the risk of reinfection. These findings support the safe use of PAI as an adjunct to optimize postoperative pain control and reduce opioid exposure in this high-risk population.