title: Use of low-dose steroids in decreasing cytokine release during bilateral total knee replacement.
abstract: BACKGROUND
  Interleukin 6 (IL-6), a marker of inflammation, is one of the major cytokines released during joint replacement. In the orthopedic patient population, high levels have been linked to many adverse effects including acute respiratory distress syndrome, postoperative mental status changes, and fever. We looked to assess the efficacy of low-dose steroids on the postinflammatory response as measured by IL-6 in patients undergoing bilateral total knee replacement (BTKR). The role of steroids has never been evaluated before in that setting.
  
  
  METHODS
  Double-blind, randomized, placebo-controlled study of 30 patients undergoing BTKR. The study was powered in order to detect at least a 25% decrease in IL-6 from control. Hydrocortisone (100 mg) or placebo was given at 2 doses 8 hrs apart to the study and control group respectively. Clinical outcome was assessed as well.
  
  
  RESULTS
  Levels of IL-6 were 40% lower in the study group by 10 hrs (P = 0.0037) but were similar to the control group at 24 hrs. Greater hemodynamic stability was noted in the study group with fewer episodes of hypotension postoperatively (P = 0.031). Range of motion gained on discharge was also greatest in the study group (P = 0.049). Absence of infection and normal wound healing were noted in all patients.
  
  
  CONCLUSIONS
  The use of hydrocortisone significantly decreased the inflammatory response in patients undergoing BTKR as measured by IL-6 production. Further studies looking at clinical implications of such findings in a larger patient population and with a longer course of steroids are warranted.
authors: Department of Anesthesiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA. JulesElyseeK@hss.edu
authors: Kethy M
authors: KM
authors: Jules-Elysee
authors: Jane Y
authors: JY
authors: Lipnitsky
authors: Neesa
authors: N
authors: Patel
authors: George
authors: G
authors: Anastasian
authors: Sarah E
authors: SE
authors: Wilfred
authors: Michael K
authors: MK
authors: Urban
authors: Thomas P
authors: TP
authors: Sculco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D015536:Down-Regulation; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007249:Inflammation / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009519:New York City; D010147:Pain Measurement; D015990:Placebo Effect; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000187:drug effects; D020127:Recovery of Function; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D013256:Steroids; D006854:Hydrocortisone