The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty

Bone Joint J. 2016 Sep;98-B(9):1189-96. doi: 10.1302/0301-620X.98B9.36250.


Aims: 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 the attainment of discharge criteria and recovery one year after total knee arthroplasty (TKA). The hypothesis was that LIA would increase the proportion of patients discharged from rehabilitation by the fourth post-operative day but would not affect outcomes at one year.

Patients and methods: A total of 242 patients were randomised; 20 were excluded due to failure of spinal anaesthesia leaving 109 patients in the PCEA group and 113 in the LIA group. Patients were reviewed at six weeks and one year post-operatively.

Results: There was no difference in the proportion of patients discharged from rehabilitation by the fourth post-operative day, (77% in the PCEA group, 82% in the LIA group, p = 0.33), mean length of stay (four days in each group, p = 0.540), day of first mobilisation (p = 0.013) or pain (p = 0.278). There was no difference in mean Oxford Knee Scores (41 points in each group, p = 0.915) or the rate of complications in the two groups.

Conclusion: Both techniques provided adequate pain relief, enabled early mobilisation and accelerated rehabilitation and good patient-reported outcomes up to one year post-operatively. PCEA and LIA are associated with similar clinical outcomes following TKA. Cite this article: Bone Joint J 2016;98-B1189-96.

Keywords: Epidural; Local infiltration analgesia; Rehabilitation; Total knee arthroplasty.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Analgesia, Epidural / methods
  • Analgesia, Patient-Controlled / methods*
  • Anesthesia, Local / methods*
  • Anesthetics, Local / administration & dosage
  • Arthroplasty, Replacement, Knee / methods
  • Arthroplasty, Replacement, Knee / rehabilitation*
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pain Measurement*
  • Pain, Postoperative / prevention & control*
  • Perioperative Care / methods
  • Pilot Projects
  • Risk Assessment
  • Treatment Outcome


  • Anesthetics, Local