Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty |
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| Authors: | Viktoria Lindberg-Larsen Thomas Q Bandholm Camilla K Zilmer Jens Bagger Mette Hornsleth Henrik Kehlet |
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| Affiliation: | 1. Section for Surgical Pathophysiology, Copenhagen University Hospital;2. The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen;3. Physical Medicine &4. Rehabilitation Research-Copenhagen (PMR-C), Department of Physical Therapy, Clinical Research Centre, and Department of Orthopedic Surgery, Copenhagen University Hospital;5. Department of Physical Therapy, Copenhagen University Hospital;6. Department of Orthopedic Surgery, Copenhagen University Hospital, Denmark |
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| Abstract: | Background and purpose — Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss of knee-extension strength at discharge after fast-track TKA.Patients and methods — 70 patients undergoing elective unilateral TKA were randomized (1:1) to preoperative intravenous (IV) MP 125?mg (group MP) or isotonic saline IV (group C). All procedures were performed under spinal anesthesia without tourniquet, and with a standardized multimodal analgesic regime. The primary outcome was change in knee-extension strength from baseline to 48?hours postoperatively. Secondary outcomes were knee joint circumference, functional performance using the Timed Up and Go (TUG) test, pain during the aforementioned tests, rescue analgesic requirements, and plasma C-reactive protein (CRP) changes.Results — 61 patients completed the follow-up. The loss in quadriceps muscle strength was similar between groups; group MP 1.04 (0.22–1.91) Nm/kg (–89%) vs. group C 1.02 (0.22–1.57) Nm/kg (–88%). Also between-group differences were similar for knee circumference, TUG test, and pain scores. MP reduced the inflammatory response (CRP) at 24?hours postoperatively; group MP 33 (IQR 21–50) mg/L vs. group C 72 (IQR 58–92) mg/L (p < 0.001), and 48?hours postoperatively; group MP 83 (IQR 56–125) mg/L vs. group C 192 (IQR 147–265) mg/L (p < 0.001), respectively.Interpretation — Preoperative systemic administration of MP 125?mg did not reduce the pronounced loss of knee-extension strength or other functional outcomes at discharge after fast-track TKA despite a reduced systemic inflammatory response. |
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