Pre-op methylprednisolone beneficial in knee arthroplasty

(HealthDay)—For patients undergoing elective unilateral total knee arthroplasty, preoperative administration of methylprednisolone is associated with reduced circulating markers of endothelial activation and damage, according to a study published online July 28 in Anaesthesia.

Viktoria Lindberg-Larsen, M.D., from Copenhagen University Hospital in Denmark, and colleagues randomized 70 patients undergoing elective unilateral total knee arthroplasty to receive preoperative intravenous methylprednisolone 125 mg or isotonic saline in a 1:1 ratio. Using a standardized multimodal analgesic regime, all procedures were performed under spinal anesthesia without a tourniquet.

The researchers found that, compared with saline, methylprednisolone significantly reduced markers of endothelial damage at 24 hours following surgery (adjusted means expressed by circulating Syndecan-1: 11.6 versus 13.4 ng/mL⁻¹ [P = 0.046]; soluble thrombomodulin: 5.1 versus 5.7 ng/mL⁻¹ [P = 0.009]; sE-Selectin: 64.8 versus 75.7 ng/mL⁻¹ [P = 0.001]; and vascular endothelial growth factor: 35.3 versus 58.5 ng/mL⁻¹ [P < 0.001]). For soluble thrombomodulin, sE-Selectin, and vascular endothelial growth factor, the effect of the intervention increased with time and was more pronounced in patients with high baseline values. Methylprednisolone also correlated with a reduction in C-reactive protein response 24 hours postoperatively (31.1 versus 68.4 mg/L⁻¹ [P < 0.001]).

"These findings may have a positive effect on surgical outcome, but require studies in major surgery," the authors write.

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