J Knee Surg
DOI: 10.1055/s-0038-1636506
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multiple Low Doses of Intravenous Corticosteroids to Improve Early Rehabilitation in Total Knee Arthroplasty: A Randomized Clinical Trial

Donghai Li*
1  Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
,
Jinhai Zhao*
1  Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
,
Zhouyuan Yang
1  Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
,
Pengde Kang
1  Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
,
Bin Shen
1  Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
,
Fuxing Pei
1  Department of Orthopaedics Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
› Author Affiliations
Further Information

Publication History

16 October 2017

28 January 2018

Publication Date:
07 March 2018 (eFirst)

Abstract

Low doses of corticosteroids have been proved to be effective in decreasing the inflammatory cytokines and relieving the pain. However, the optimal dosage of corticosteroids in total knee arthroplasty (TKA) is undetermined. A total of 103 patients were randomly divided into three groups. Group A containing 32 patients received normal saline. Group B including 36 patients used two doses of 100 mg hydrocortisone, given 2 hours before and 8 hours after surgery. Group C involving 35 patients received four doses of 100 mg hydrocortisone, 8 hours apart.

The level of interleukin 6 (IL-6) and C-reactive protein (CRP) were lower in group C than those in group A when detected at 12, 24, and 48 hours after operation and even lower than that in group B at 24 and 48 hours (p < 0.05, all). The visual analog scale (VAS) pain scores were significantly reduced by using two doses of hydrocortisone at the first 12 hours compared with group A (p > 0.05), but it did not show statistic difference 24 hours later (p > 0.05). For comparison, patients with multiple doses achieved continuously better outcomes on pain management than the blank control group within postoperative 36 hours at rest and at 24 hours with activity. In addition, patients using multiple doses of hydrocortisone achieved fewer occurrences of nausea and vomiting, fever, and sleeplessness, better knee function recovery, better patient satisfaction, and shorter length of hospital stays (p < 0.05, all).

Multiple dose of hydrocortisone was benefit to the pain management and early rehabilitation in TKA and may be recommended to the clinical practice.

Ethical Approval

This study was approved by the Clinical Trials and Biomedical Ethics Committee of West China Hospital, and written informed consents were obtained from all participants.


* Donghai Li and Jinhai Zhao contributed equally to this work.