Hydrocortisone protects bilateral knee replacement patients

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By Lynda Williams, Senior medwireNews Reporter

Repeat doses of corticosteroids may protect patients undergoing bilateral total knee arthroplasty (TKA) from postoperative side effects such as fever, pain, and acute respiratory distress, research suggests.

The results of a randomized placebo-controlled trial show that patients given hydrocortisone 100 mg 2 hours before surgery, followed by two further doses at 8-hour intervals, had a significantly lower 24-hour peak concentration of the cytokine interleukin (IL)-6 than controls, at 148.13 versus 623.74 pg/mL.

In addition, levels of the elastin by-product desmosine were unchanged in the hydrocortisone-treated patients at baseline, 24, and 72 hours after bilateral TKA, but rose significantly in controls, from 90.96 to 134.75 pmol/mg at 24 hours.

"Lower IL-6 levels suggest a lower level of inflammation, and lower desmosine levels suggest a lower level of lung injury, as a clinical effect of perioperative corticosteroid administration," say Kethy Jules-Elysee (Hospital for Special Surgery, New York, USA) and co-authors.

The research follows on from study findings indicating that two doses of hydrocortisone, 8 hours apart, significantly reduced initial IL-6 levels compared with placebo in bilateral TKA patients, even though IL-6 levels were comparable in the two groups 24 hours after surgery.

In the current study, the 17 patients given hydrocortisone were also less likely to develop fever than the 17 controls (11.8 vs 47.1%), and had significantly lower visual analog scale pain scores 24 hours after surgery (1.4 vs 2.4).

In addition, hydrocortisone-treated patients had a significantly greater range of motion at discharge in both their left (81.4 v 73.4°) and right (81.6 vs 70.6°) knees compared with controls.

"The small study and transient clinical benefits warrant further, larger studies regarding the effects of perioperative corticosteroid on more long-term outcomes," the researchers conclude in the US edition of the Journal of Bone and Joint Surgery.

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