Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials

Chen, Yue; Rong, Wei; Liu, Youwen

doi:10.1186/s13018-017-0601-4

Cited by 73 publications

(57 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is well-known that pain is an important in uencing factor for patients' satisfaction with surgery. In the trial, the same enhanced recovery after surgery and postoperative rehabilitation training were used in all groups [27,28]. The analysis of the results showed that the visual analogue scale at 1, 3 and 7 d after the second half of tourniquet application was signi cantly greater than that in the other two groups.…”

Section: Discussionmentioning

confidence: 99%

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

Yin¹,

Wang²,

Zuo³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Tourniquets are widely used in TKA, but few articles state the difference in postoperative effects between restricting tourniquet use and not.Objective:We hoping that this experiment will look at the effect of limited tourniquet use on enhanced recovery in TKA. Methods: 150 patients who received TKA in the Affiliated Hospital of Chengdu University of TCM from June 2018 to December 2019 were randomly selected and randomly divided into 3 groups: ①limited use tourniquet group: after the completion of osteotomy, tourniquet was applied only when the prosthesis was installed, ②second half tourniquet group: Install prosthesis until suture is complete ③ no tourniquet group: no tourniquet was used throughout. The postoperative venous blood hemoglobin, C-reactive protein, visual analogue scale and HSS score were compared among the three groups. Results: Compared with the restricted use of tourniquet group, the visual analogue scale of knee joint pain and venous blood C-reactive protein level at 1 and 3 d after operation and hemoglobin level at 1 d after operation in the second half of tourniquet group increased and the HSS score at 3 and 7 d after operation decreased (P <0.05).No significant differences in visual analogue scale,HSS score,C-reactive,and hemoglobin between the restricted tourniquet and the no tourniquet. Conclusion: The results confirmed that the use of tourniquet in the second half of TKA would aggravate the early postoperative pain. In the effect of early rehabilitation, there is no significant between limited use of tourniquet or no use.

show abstract

Section: Discussionmentioning

confidence: 99%

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

Yin¹,

Wang²,

Zuo³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…4 Interest has recently grown in the perioperative systemic use of steroids in patients undergoing total knee and hip replacement, with a number of well-designed studies, systematic reviews and metanalyses being published. 6,11,17 However it is di cult to make comparisons between studies due to the variation in the doses and types of steroids used, as well as the timing of administration. A meta-analysis of randomized trials by Yue et al con rmed that steroid injections offer positive bene ts in terms of lower incidence of postoperative nausea and vomiting, as well as reduction of acute postoperative pain, hospital stay, without signi cant complications or adverse events.…”

Section: Discussionmentioning

confidence: 99%

Oral prednisolone administration in postoperative period improves results of TKA in patient with severe range of motion limitation – a paired outcome study

Grzelecki

Kowalczewski

Kordasiewicz

et al. 2020

Preprint

View full text Add to dashboard Cite

Background. One of the most common problems related to total knee arthroplasty (TKA) is postoperatively limited range of motion, especially in the most difficult cases. The aim of the study was to assess the influence of oral use of prednisolone in the postoperative period on the final results in a patient after TKA with severely limited postoperative range of motion.Methods. Thirty-two patients (32 knees) with a mean age of 61.2 years were selected from our prospectively-collected data base with severe knee range of motion limitation (rheumatoid arthritis, psoriasis, ankylosing spondylitis, posttraumatic and postoperative osteoarthritis). Prednisolone was administrated in two doses per day (1 mg per kg of body mass) and then the dose was slowly reduced for no more than three months. Results. The prednisolone group demonstrated significantly better results one year after the operation than the non-prednisolone group in terms of range of motion (mean extension 0.5˚ and 3.0˚; p=0.02, mean flexion 100.1˚ and 88˚; p= 0.01), WOMAC (mean 85.0 and 76.8 points; p=0.02) and KSS clinical score (mean 86.9 and 81.7; p=0.001) and KSS functional score (79.3 and 71.0 points; p=0.01). No significant differences were observed between the groups in terms of postoperative systemic and surgical site complications; therefore, no complications could be defined as steroid related. Conclusions. The administration of oral prednisolone for a longer postoperative time in patients with severe preoperative range of motion following TKA significantly improves functional results without steroid related complications at one year follow-up.

show abstract

“…Dexamethasone (DEX), with a strong anti‐inflammatory agent, has been widely used to reduce inflammatory markers, prevent PONV, and relieve postoperative pain and fatigue in various perioperative periods. Many previous randomized controlled trials (RCT) and meta‐analyses have demonstrated the effectiveness of DEX in preventing inflammatory stress, without the disadvantages of the wound and gastrointestinal bleeding complications in THA. The combined application of DEX and TXA has been reported in a few studies; however, the additional effects of the combined administration are not completely clear.…”

Section: Introductionmentioning

confidence: 99%

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

et al. 2020

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective: To evaluate the efficacy and safety of combined use of tranexamic acid (TXA) and dexamethasone (DEX) for anti-inflammatory and clinical outcomes after total hip arthroplasty (THA). Methods:A total of 100 patients were included in this randomized, controlled study. Patients in the TXA + DEX group were administered TXA at a dose of 15 mg/kg, which was repeated 3 h after THA, and received 20 mg DEX. In contrast, patients in the TXA group were administered TXA at a dose of 15 mg/kg, which was repeated at 3 h postoperatively. C-reactive protein (CRP), interleukin-6 (IL-6) and pain levels, incidence of postoperative nausea and vomiting (PONV), total blood loss and transfusion rates, postoperative fatigue, range of motion (ROM), length of hospital stay (LOS), analgesic rescue and antiemetic rescue consumption, and complications were compared in both groups. Results:The CRP and IL-6 levels were lower in the TXA + DEX group than in the TXA group (all P < 0.001) at 24 h, 48 h, and 72 h postoperatively. Patients in the TXA + DEX group had lower pain scores at rest and walking at 24 h postoperatively (all P < 0.001). In the TXA + DEX group, the incidence of PONV was lower (P = 0.005), postoperative fatigue (P < 0.001) was reduced, and analgesia and antiemetic rescue consumption were also reduced. The total blood loss, transfusion rate, LOS and hip ROM were similar in the two groups. There was no thrombosis, infection, or gastrointestinal bleeding in either group.Conclusion: Compared to TXA alone, the combination of TXA + DEX can reduce postoperative inflammatory response, relieve pain, and reduce PONV and fatigue, without increasing the risk of complications. Therefore, the present study suggested that the combination of TXA + DEX is an effective and safe accelerated rehabilitation strategy for patients receiving primary unilateral THA.

show abstract

Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials

Cited by 73 publications

References 35 publications

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

Oral prednisolone administration in postoperative period improves results of TKA in patient with severe range of motion limitation – a paired outcome study

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

Contact Info

Product

Resources

About