Intravenous Corticosteroids to Improve Early Rehabilitation in Total Knee Arthroplasty

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

We read with great interest the article of Li et al recently published in Journal of Knee Surgery.[1] The authors performed a prospective randomized study on 103 patients undergoing total knee arthroplasty and concluded that patients who received multiple doses of hydrocortisone 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. The authors should be congratulated for performing a study on an important topic (e.g., early recovery) in patients undergoing orthopaedic surgery.[2] [3] The current emphasis on the need to use multimodal agents to improve postoperative pain makes the topic very relevant in surgery.[4] [5]

Although the study of Li et al was well designed and conducted, there are some questions regarding the study that need to be clarified by the authors. First, it is unclear if the authors had a standardized intraoperative analgesic regimen as this can alter the main outcomes. Second, it is also unclear if the authors have standardized the use of regional anesthesia and postoperative analgesic strategies. Finally, the use of multiple doses of hydrocortisone may cause immunosuppression and adrenal suppression which could lead to severe adverse events to the patients who were not detected due to the small sample size used in the study.[6]

We would welcome comments to address the aforementioned issues as they were not discussed by the authors. This would further validate the findings of this important clinical study.

• References

• 1 Li D, Zhao J, Yang Z, Kang P, Shen B, Pei F. Multiple low doses of intravenous corticosteroids to improve early rehabilitation in total knee arthroplasty: a randomized clinical trial. J Knee Surg 2018 Doi: 10.1055/s-0038-1636506
• 2 Lu J, Chen G, Zhou H, Zhou Q, Zhu Z, Wu C. Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: a randomized double blinded controlled trial. J Clin Anesth 2017; 41: 30-34
• 3 Drew JM, Neilio J, Kunze L. Contemporary perioperative analgesia in total knee arthroplasty: multimodal protocols, regional anesthesia, and peripheral nerve blockade. J Knee Surg 2018; 31 (07) 600-604
• 4 Zhang Z, Xu H, Zhang Y. , et al. Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: a meta-analysis of randomized controlled trials. J Clin Anesth 2017; 43: 84-89
• 5 Li XD, Han C, Yu WL. Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials. J Clin Anesth 2017; 41: 76-83
• 6 MacKenzie CR, Goodman SM. Stress dose steroids: myths and perioperative medicine. Curr Rheumatol Rep 2016; 18 (07) 47