safety study of high-dose methylprednisolone in fast-track total knee arthroplasty

Conditions: Infection of Total Knee Joint Prosthesis

Summary: it has been shown that a single high dose of steroid before surgery may reduce pain the first 48 hours after insertion of a new joint in the knee, a so called "total knee arthroplasty" (tka). consequently, this has been introduced as standard treatment of most patients at several danish orthopedic departments. although there are some concerns about the possibility of increased risk of prosthesis infections, this has not been proved in previous studies. however the studies are few, have limited number of patients and are not done using a standardized perioperative set-up. this study is made to monitor the safety of a single high dose steroid injection before tka, with regards to prosthesis infection within one year of surgery. we hypothesize that there will be no increase in infections in patients receiving steroid injection before tka compared to a historical cohort of patents who did not receive a steroid injection before their tka.

in order to reduce pain intensity as much as possible after surgical procedures, modern multimodal analgesic strategies using different analgetics targeting different mechanism of the pain reception system are used. at the same time this may reduce the use of opioids, which commonly cause sideeffects such as nausea, vomiting, obstipation,urinary retention, itching, respiratory suppression and sedation. in spite of the use of a wide perioperative multimodal analgesia, pain after total knee arthroplasty (tka), is stil a considerable clinical problem and need for optimisation of the immediate postoperative pain treatment. there is evidence that "high"dose glucocorticoids administered preoperatively reduces the level of pain and the use of opioids after surgery. a recent review did not give cause for concern regarding use of glucocorticoids in tka,but found that data on longterm safety aspects are lacking, why no recommendations could be made. as the limited evidence presently points to af benefit of glucocorticoids without serious side effects, the treatment has been introduced as standard treatment in tka at several of the departments participating in the lundbeck foundation centre for fast-track hip and knee replacement collaboration. this study is made to monitor the safety of high dose steroid injection before tka, with regards to prosthesis infection within one year of surgery. we hypothesize that there will be no increase in infections in patients receiving steroid injection before tka compared to a historical cohort of patents who did not receive a steroid injection before their tka.

Eligibility criteria:
inclusion criteria: * patients scheduled for primary unilateral elective tka and no contraindications for high-dose methylprednisolone preoperatively * danish social security number exclusion criteria: one of the following contraindications for methylprednisolone: * allergy against methylprednisolone. * currently in systemic treatment with glucocorticoid * current gastric ulcer * insulin dependent diabetes mellitus further contraindications are at the discretion of the individual department/surgeon. the cohort without preoperative methylprednisolone treatment will be followed as a separate cohort to identify potential selection bias. - citizens without danish social security number are not eligible for this study as follow-up is not possible.

Keywords: orthopedic surgery infections steroid fast-track total knee arthroplasty safety