title: The Effect of Perioperative Corticosteroids in Total Hip Arthroplasty: A Prospective Double-Blind Placebo Controlled Pilot Study.
abstract: Surgery produces a rapid rise in interleukin 6 (IL-6) which may increase the risk of deep vein thrombosis and medical complications. Perioperative corticosteroids suppress IL-6 release in patients undergoing total knee arthroplasty. This study evaluates the effects of a perioperative corticosteroid regimen on IL-6 formation, thrombogenesis, fibrinolysis, and clinical outcomes in patients undergoing unilateral, uncemented, total hip arthroplasty.
  
  
  
  Twenty-seven patients (14 placebo and 13 study) were enrolled in this randomized, double-blind, placebo-controlled trial. The study group received 20 mg of prednisone orally followed by 2 doses of intravenous hydrocortisone, each 8 hours apart. Blood was drawn at several time points for IL-6, prothrombin fragment 1.2, and plasmin-alpha-2-antiplasmin complex, a marker of fibrinolysis. In-hospital visual analog pain (visual analog scale) scores, patient-controlled analgesia use, and ability to climb stairs were recorded.
  
  
  
  Mean serum IL-6 levels at 6 and 24 hours postoperatively were significantly lower for the study group, whereas serum prothrombin fragment 1.2 and plasmin-alpha-2-antiplasmin were not statistically different at any study time point. Average pain scores were similar (P > .05), but study group experience less severe pain (P < .01) and less patient-controlled analgesia (P = .02). At 3 months, 4 patients in the placebo and 1 patient in the study group had difficulty going up and down staircases (P = .08).
  
  
  
  The use of corticosteroids was associated with a statistically significant decrease in IL-6 at 6 and 24 hours postoperatively but did not affect thrombogenic markers. The study group had improved postoperative analgesia and a trend toward improved functional outcome at 3 months postoperatively.
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sculco
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Hospital for Special Surgery, New York, New York.
authors.forename: Natasha
authors.initials: N
authors.lastname: Desai
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Su
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Padgett
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, New York.
authors.forename: Kethy
authors.initials: K
authors.lastname: Jules-Elysee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010446:Peptide Fragments / Q000097:blood; D010865:Pilot Projects; D011184:Postoperative Period; D011446:Prospective Studies; D011516:Prothrombin; D000979:alpha-2-Antiplasmin / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; C508600:IL6 protein, human; D015850:Interleukin-6; D010446:Peptide Fragments; D000979:alpha-2-Antiplasmin; C037742:plasmin-plasmin inhibitor complex; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D005341:Fibrinolysin
keywords: IL-6; clinical outcomes; perioperative corticosteroids; thrombogenic markers; total hip arthroplasty