JOA - 2026-06-09 - Journal Article
Intraosseous Sustained-Release Anesthetics Promote Early Ambulation and Functional Recovery after Total Knee Arthroplasty.
Huang J, Abdullah Ezzi SH, Wu S, Ali Alshabi MM, Zhang W, Adil MM, Cao X
Topics
Key Takeaway
Adding intraosseous liposomal bupivacaine to standard periarticular LIA reduced VAS pain scores at rest and with ambulation on POD1 and POD3, and extended PCEA use time from 14.8 to 18.7 hours in TKA patients aged 65–90.
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Summary
This open-label RCT compared standard periarticular LIA (10 mL sustained-release anesthetic) versus LIA plus intraosseous infiltration of the tibial osteotomy surface (additional 10 mL) in 110 TKA patients with mean age 75 years. The LIA+TIA group demonstrated significantly lower VAS scores at rest and with walking on POD1 and POD3, greater walking distance, and superior ROM and flexion at both time points. PCEA duration was significantly longer in the LIA+TIA group (18.7 vs. 14.8 hours, P<0.001), suggesting reduced breakthrough pain requirements.
Key Limitation
Follow-up is limited to 3 days, providing no data on whether the early functional advantage is sustained, and no safety data on intraosseous liposomal bupivacaine delivery (infection risk, implant-cement interface effects, systemic absorption) are reported.
Original Abstract
BACKGROUND
Postoperative pain is a primary impediment to functional recovery in patients who undergo total knee arthroplasty (TKA).This work aimed to evaluate the efficacy of intraosseous sustained-release anesthetics, administered into the subchondral trabecular space before the insertion of a prosthesis during TKA, in promoting early ambulation and functional recovery.
METHODS
This randomized controlled open-label study was carried out on 110 patients who had a mean age of 75 years (range, 65 to 90). Patients were subdivided into two groups: Local infiltration anesthesia (LIA) group : 10 mL of sustained-release anesthetic injection solution was taken, and infiltration anesthesia was applied in the joint and around the incision (two mL was injected into the posterior joint capsule and lateral collateral ligaments, two mL was injected into the knee-extension device and the parapatellar, and six mL was injected into the periarticular soft tissues); and Local infiltration anesthesia + intraosseous infiltration anesthesia (TIA) or Group LIA plus
TIA
a sustained-release anesthetic injection solution of 20 mL, 10 mL as described before plus intraosseous infiltration anesthesia on the osteotomy surface of the tibia (10 mL).
RESULTS
Visual analog scale (VAS), at rest and during walking, was significantly lower at days one and three in group LIA plus TIA than in group LIA (P < 0.05). Patient-controlled epidural analgesia (PCEA) time was significantly higher in the experimental group (LIA plus TIA) than the control group (LIA) (18.7 versus 14.8, P < 0.001). The walking distance was significantly higher on day one and day three in group LIA plus TIA than in group LIA (P < 0.05). Flexion and ROM (range of motion) were significantly higher at day one and day three in group LIA plus TIA than in group LIA (P < 0.05). Flexion and ROM were significantly higher at days one and three in group LIA plus TIA than in group LIA (P < 0.05).
CONCLUSIONS
The intraosseous injection of liposomal bupivacaine may be a potentially effective method for post-TKA analgesia, significantly promoting early walking and functional recovery after TKA.