The Effect of Perioperative Corticosteroids in Total Hip Arthroplasty: A Prospective Double-Blind Placebo Controlled Pilot Study.

Autor: Sculco PK; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., McLawhorn AS; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Desai N; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Hospital for Special Surgery, New York, New York., Su EP; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Padgett DE; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Jules-Elysee K; Department of Anesthesiology, Hospital for Special Surgery, New York, New York.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2016 Jun; Vol. 31 (6), pp. 1208-1212. Date of Electronic Publication: 2015 Dec 17.
DOI: 10.1016/j.arth.2015.11.011
Abstrakt: Background: Surgery produces a rapid rise in interleukin 6 (IL-6) which may increase the risk of deep vein thrombosis and medical complications. Perioperative corticosteroids suppress IL-6 release in patients undergoing total knee arthroplasty. This study evaluates the effects of a perioperative corticosteroid regimen on IL-6 formation, thrombogenesis, fibrinolysis, and clinical outcomes in patients undergoing unilateral, uncemented, total hip arthroplasty.
Methods: Twenty-seven patients (14 placebo and 13 study) were enrolled in this randomized, double-blind, placebo-controlled trial. The study group received 20 mg of prednisone orally followed by 2 doses of intravenous hydrocortisone, each 8 hours apart. Blood was drawn at several time points for IL-6, prothrombin fragment 1.2, and plasmin-alpha-2-antiplasmin complex, a marker of fibrinolysis. In-hospital visual analog pain (visual analog scale) scores, patient-controlled analgesia use, and ability to climb stairs were recorded.
Results: Mean serum IL-6 levels at 6 and 24 hours postoperatively were significantly lower for the study group, whereas serum prothrombin fragment 1.2 and plasmin-alpha-2-antiplasmin were not statistically different at any study time point. Average pain scores were similar (P > .05), but study group experience less severe pain (P < .01) and less patient-controlled analgesia (P = .02). At 3 months, 4 patients in the placebo and 1 patient in the study group had difficulty going up and down staircases (P = .08).
Conclusion: The use of corticosteroids was associated with a statistically significant decrease in IL-6 at 6 and 24 hours postoperatively but did not affect thrombogenic markers. The study group had improved postoperative analgesia and a trend toward improved functional outcome at 3 months postoperatively.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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