DOS 2016

DOS Kongressen 2016 ·

Preoperative Methylprednisolone does not reduce

the loss of Knee-Extension Strength after Fast-Track

Total Knee Arthroplasty - a randomized, double-blind,

placebo-controlled trial

Viktoria Lindberg-Larsen, Thomas Bandholm, Camilla Zilmer, Hornsleth Mette,

Bagger Jens, Kehlet Henrik

Section for Surgical Pathophysiology, and The Lundbeck Foundation Centre for Fast-

Track Hip and Knee Arthroplasty, Copenhagen University Hospital, Rigshospitalet; Physical

Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical

Therapy, Clinical Research Centre, and Department of Orthopedic Surgery, Copenhagen

University Hospital, Hvidovre; Department of Physical Therapy, Copenhagen University

Hospital, Bispebjerg; Department of Orthopedic Surgery, Copenhagen University

Hospital, Bispebjerg; Section for Surgical Pathophysiology, and The Lundbeck Foundation

Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen University Hospital,

Rigshospitalet

Background:

Early mobilization and functional performance is delayed due to postoper-

ative quadriceps weakness after total knee arthroplasty (TKA). Central activation failure

of the quadriceps muscle due to neuro- inflammation seems to contribute considerably

to the decrease in knee- extension strength.

Purpose / Aim of Study:

The purpose was to evaluate the efficacy of a single pre-

operative dose of systemic methylprednisolone (MP) on knee-extension strength after

fast- track TKA.

Materials and Methods:

70 patients undergoing elective unilateral TKA at a single

center were randomized (1:1) receiving preoperative MP 125 mg IV (group M) or iso-

tonic saline IV (group C). All procedures were performed under spinal anesthesia without

Tourniquet, and a standardized, multimodal analgesic regime was used. The primary out-

come was change in knee- extension strength between groups from baseline to 48 hours

postoperatively. Secondary outcomes were knee joint circumference, functional perfor-

mance (Timed Up and Go (TUG)), plasma C-reactive protein (CRP) concentration, pain

during aforementioned tests and rescue analgesic requirements. Trial ID: NCT02319343

Findings / Results:

MP significantly reduced the inflammatory response (CRP): 24

hours postoperatively; group M 33 (IQR 21-50) mg/l vs. group C 72 (IQR 58-92) mg/l,

p<0.001, and 48 hours postoperatively; group M 83 (IQR 56- 125) mg/l vs. group C

192 (IQR 147- 265) mg/l, p<0.001, but loss in quadriceps muscle strength did not dif-

fer between groups: group M 1.04 (SD 0.42) Nm/kg vs. group C 1.02 (SD 0.35) Nm/

kg, p=0.843. No between- group differences were observed for knee circumference,

TUG, and pain scores.

Conclusions:

Preoperative systemic administration of MP 125 mg reduced the inflam-

matory response but was not superior to placebo in reducing the loss of knee-extension

strength and functional performance early after fast- track TKA.

No conflicts of interest reported

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