Peri-operative analgesic method does not affect rehabilitation outcomes following total knee arthroplasty

This non-blinded randomised controlled trial compared the effect of patient controlled epidural analgesia (PCEA) versus local infiltration analgesia (LIA) within an established Enhanced Recovery Programme on attainment of discharge criteria and recovery at one year following surgery. The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by post-operative day four but not affect outcomes at one year. 242 patients were
randomized with 109 patients receiving PCEA (mean age 66 SD (11)) and 113 receiving LIA (mean age 68 SD (10)). Patients were followed up at six weeks and one year. No difference was noted in the proportion of patients discharged from rehabilitation by post-operative day 4, PCEA =77% vs. LIA =82% (p=0.33) or mean length of stay (both 4 days, p=0.540). No difference was observed in day of first mobilisation (p= 0.013) or pain scores (P=0.278). At one year follow up
there were no differences in Oxford Knee Scores (both 41, p=0.915) or complication rates (two vs. six, p=0.281). Both techniques provided adequate pain relief, enabled early ambulation and accelerated rehabilitation and continued improvement in functional and patient reported outcomes up to one year following surgery. PCEA and LIA enable equitable clinical outcomes
following TKA.