Research Reveals Positive Effects of Corticosteroids After Total Knee Arthroplasty

After Knee Surgery

For sufferers of severe arthritis in the knee, replacement of the knee joint with a prosthetic, or Total Knee Arthroplasty (TKA), may be the only viable option. The procedure is certainly invasive and intense, but it’s helped countless people find relief from their condition. In fact, a robust 90 percent of post-operative patients have much less knee pain, and 85 percent of prosthetic knees still function after 20 years. [1] However, it’s important to think about what recovery is like after such an invasive operation.

One of the biggest issues that arises after TKA is intense and severe inflammation of the area due to the tissue healing itself. This reaction, called an acute phase response (APR), can become dangerous: in addition to pain, patients may experience nausea and venous thromboembolism, a potentially fatal clotting of deep arteries. [2] Recovery is therefore a fraught time, requiring observation and medication.

Recently, however, a team of researchers under the direction of Dr. Adam Brekke has found that corticosteroids applied after TKA can effectively manage these symptoms. [2] Let’s take a closer look at this groundbreaking research.

Retrospective Analysis

Obviously, since the study involved looking at patients after TKA, it was retrospective in nature. Dr. Brekke and his team at the Vanderbilt University Medical Center recruited 188 post-operative patients and split them into two groups: one that included administration of a specific corticosteroid, dexamethasone, on the day after surgery, and another that did not.

They looked at several measures to assess efficacy:

• C-reactive Protein: Levels of this protein increase in response to inflammation.
• Fibrinogen: Another protein that arises in areas of injury; its components end up forming blood clots.
• Morphine Equivalents: Levels of morphine required by patients to manage pain.
• Anti-emetic Doses: Anti-emetic drugs are those that help reduce levels of nausea.

Measurements were taken for the first few days after surgery, and after a period of two weeks. This would give the team a strong sense of just how effective corticosteroids can be in managing issues that arise after TKA.

Robust Results

Across the board, Dr. Brekke and his colleagues found better outcomes for those that included dexamethasone in their post-operative regimen. They found significantly lower levels of C-reactive protein and fibrinogen in the corticosteroid group at one day, two days, and two weeks after surgery. In keeping with their hypothesis, significant decreases in morphine equivalents and anti-emetic doses were also observed, meaning patients were feeling less pain and nausea.

While more research is needed to confirm the results, the use of corticosteroids after TKA had shown its utility. As Dr. Brekke and the team note, the implications of this finding are significant  because severe inflammation after surgery can become a serious problem. In fact, in some cases, the pain and other symptoms even exceed that of the arthritic knee initially. It gets complicated, though, because some inflammation is necessary for proper healing. The exact levels and the exact scope of this effect need to be further explored.

Better Outcomes

At the end of the day, there’s no doubt that treatments are getting more efficient at taking on orthopedic issues. The options today are more effective and have less complications than what was standard practice even 10 years ago. Today’s sufferers, put simply, are in a better position than ever before. What this means is that, if you or a loved one is living in pain and discomfort, there should be no hesitation to seek help. With the right medical team, there’s no doubt that the issue will resolve. You’ll get your quality-of-life back, and that’s priceless.

 

If you suffer from arthritis of the knee or any other orthopedic issue, the team at Onward Orthopedics can help. The experts here employ the latest in treatments and techniques to ensure positive outcomes for their patients. Learn more about their dedicated approach to care by calling (800) 577-1693 today!

 

References

1. “Knee Replacement Surgery Success Rate, Statistics, And Outcomes”. 2018. Healthline. Accessed September 11 2018. https://www.healthline.com/health/total-knee-replacement-surgery/outcomes-statistics-success-rate.
2. Brekke, Adam C., Emilie Amaro, Samuel L. Posey, Stephen M. Engstrom, Gregory G. Polkowski, and Jonathan G. Schoenecker. 2018. “Do Corticosteroids Attenuate The Perioperative Acute Phase Response After Total Knee Arthroplasty?”. The Journal Of Arthroplasty. Elsevier BV. doi:10.1016/j.arth.2018.08.033.