ARTHROPLASTY
Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty: A randomized, double-blind, placebo-controlled trial of 61 patients
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(2):4 Acta Orthop. 2017 Oct;88(5):543-54970 patients undergoing unilateral fast-track total knee arthroplasty were included in this trial to determine if a single preoperative dose of methylprednisolone can reduce the loss of knee-extension strength at discharge. Patients were randomized to receive a preoperative injection of methylprednisolone or placebo. Outcomes included knee extension strength (Nm/kg), knee circumference, the timed up-and-go (TUG) test, knee pain, on a visual analog scale, during knee extension strength test and TUG test, and C-reactive protein levels. There were no differences between groups in the loss of knee extension strength, knee circumference, timed up-and-go tests and knee pain. C-reactive protein levels were significantly reduced in the methylprednisolone group at 24 and 48 hours.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
4/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/5
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Many patients face strength deficit in the knee following total knee arthroplasty. The inflammatory response following surgery has been theorized to be a potential major contributor to extension strength deficit. Therefore, modifying the inflammatory response with a corticosteroid, such as methylprednisolone, may help mitigate strength loss after total knee arthroplasty.
Quelle était la principale question de recherche ?
In total knee arthroplasty, does preoperative intravenous methylprednisolone lead to a significantly smaller drop in knee extension strength when compared to placebo saline, assessed at discharge?
Quels sont les résultats importants ?
- Reduction in knee extension strength from baseline to discharge did not significantly differ between the methylprednisolone group (-1.04Nm/kg [range; 0.22-1.9]) and the placebo group (-1.02Nm/kg [range; 0.22-1.6]) (p=0.8).
- The increase in VAS pain from baseline to discharge, during both strength testing and TUG test did not significantly differ between the methylprednisolone group and the placebo group (p=0.7 and 0.1, respectively).
- The increase in knee circumference from baseline to discharge did not significantly differ between the methylprednisolone group (+3.6cm [range; -1.5, 6.5]) and the placebo group (+3.8cm [range; 0.8-7.2]) (p=0.7).
- C-reactive protein levels were significantly reduced at 24 and 48 hours in the methylprednisolone group compared to the placebo group (P<0.001)
- The increase in TUG test time from baseline to discharge did not significantly differ between the methylprednisolone group (+16s [range; 2.9-40]) and the placebo group (+17s [range; 0.6-53]) (p=0.8).
De quoi dois-je me souvenir en priorité ?
In total knee arthroplasty, intravenous methylprednisolone 125mg did not have a significant effect on knee extension strength mitigation when compared to intravenous placebo saline.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The results of this study suggest that intravenous methylprednisolone in total knee arthroplasty does not have a significant benefit on early clinical parameters after surgery, including knee extension strength, knee pain, swelling, and function. Additional research should be undertaken to identify optimal strategies in recovery knee strength and function following total knee arthroplasty.
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