Document Detail

Steroid modulation of cytokine release and desmosine levels in bilateral total knee replacement: a prospective, double-blind, randomized controlled trial.
MedLine Citation:
PMID:  23097096     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The perioperative inflammatory response as measured by elevated levels of interleukin-6 (IL-6) has been linked to acute respiratory distress syndrome, postoperative confusion, and fever. Because of the extent of surgery,patients undergoing bilateral total knee arthroplasty may be at high risk of complications. We had found a significant decrease in IL-6 in patients having bilateral total knee replacement who received two doses of 100 mg of hydrocortisone eight hours apart; however, by twenty-four hours, IL-6 levels were equal to those in the group that received a placebo. In the present study, we investigated whether the administration of three doses would reduce IL-6 levels at twenty-four hours and affect other outcomes such as desmosine level, a marker of lung injury.
METHODS: After institutional review board approval, a total of thirty-four patients (seventeen patients and seventeen control subjects) were enrolled in this double-blind, randomized, placebo-controlled study. Three doses of intravenous hydrocortisone (100 mg) or placebo were given eight hours apart. Urinary desmosine levels were obtained at baseline and at one and three days postoperatively. The level of IL-6 was measured at baseline and at six, ten, twenty-four, and forty-eight hours postoperatively. Pain scores, presence of fever, and functional outcomes were recorded.
RESULTS: The level of IL-6 increased in both groups, but was significantly higher in the control group, peaking at twenty-four hours (mean and standard deviation, 623.74 ± 610.35 pg/mL versus 148.13 ± 119.35 pg/mL; p = 0.006). Urinary desmosine levels significantly increased by twenty-four hours in the control group, but remained unchanged in the study group (134.75 ± 67.88 pmol/mg and 79.45 ± 46.30 pmol/mg, respectively; p = 0.006). Pain scores at twenty-four hours were significantly lower in the study group (1.4 ± 0.9 versus 2.4 ± 1.2; p = 0.01) as was the presence of fever (11.8%versus 47.1%; p = 0.03). Range of motion at the knee was significantly greater in the study group (81.6 ± 11.6 versus 70.6 ± 14.0 in the right knee [p = 0.02] and 81.4 ± 11.3 versus 73.4 ± 9.4 in the left knee [p = 0.03]).
CONCLUSIONS: Hydrocortisone (100 mg) given over three doses, each eight hours apart, decreased and maintained a lower degree of inflammation with bilateral total knee replacement as measured by IL-6 level. Corticosteroids decreased the prevalence of fever, lowered visual analog pain scores, and improved knee motion. The significantly lower values of desmosine in the study group suggest that this treatment may be protective against lung injury.
Kethy M Jules- Elysee; Sarah E Wilfred; Stavros G Memtsoudis; David H Kim; Jacques T YaDeau; Michael K Urban; Michael L Lichardi; Alexander S McLawhorn; Thomas P Sculco
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  94     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-01-24     Completed Date:  2013-02-07     Revised Date:  2013-04-02    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2120-7     Citation Subset:  AIM; IM    
Department of Anesthesiology, 535 East 70th Street, New York, NY 10021, USA.
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MeSH Terms
Acute Lung Injury / etiology,  prevention & control*
Arthroplasty, Replacement, Knee / adverse effects,  methods*
Biological Markers / blood
Cohort Studies
Cytokines / blood,  metabolism
Desmosine / analysis,  metabolism*
Dose-Response Relationship, Drug
Drug Administration Schedule
Follow-Up Studies
Hydrocortisone / administration & dosage*
Injections, Intravenous
Interleukin-6 / blood,  metabolism*
Middle Aged
Pain Measurement / drug effects
Postoperative Complications / blood,  prevention & control
Preoperative Care / methods
Prospective Studies
Range of Motion, Articular / drug effects
Reference Values
Risk Assessment
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Biological Markers; 0/Cytokines; 0/Interleukin-6; 11003-57-9/Desmosine; 50-23-7/Hydrocortisone
Comment In:
J Bone Joint Surg Am. 2012 Dec 5;94(23):e1791-2   [PMID:  23095937 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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