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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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?
Quais foram os resultados importantes?
- 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 que é que me devo lembrar mais?
In total knee arthroplasty, intravenous methylprednisolone 125mg did not have a significant effect on knee extension strength mitigation when compared to intravenous placebo saline.
Como é que isto afectará o tratamento dos meus doentes?
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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