Anabolic steroids in patients undergoing total knee arthroplasty

Abstract

ObjectivesTo systematically review the evidence for using anabolic-androgenic steroids (AAS) to aid rehabilitation following total knee replacement (TKR).DesignSystematic review of all clinical study designs.Data sourcesMEDLINE, EMBASE, AMED, CINAHL and the Cochrane Library were searched from inception to August 2012.Eligibility criteriaAll clinical study designs without language or patient demographic limits.Outcome measuresAll functional, physiological and administrative outcomes as well as reporting of adverse events.ResultsOnly two small randomised controlled trials satisfied the inclusion criteria. Statistically significant improvements were reported in the AAS group for quadriceps strength at 3 (p=0.02), 6 (p=0.01) and 12 (p=0.02) months, Functional Independence Measure score at 35 days (p=<0.05) and Knee Society Score at 6 weeks (p=0.02), 6 months (p=0.04) and 12 months (p=0.03). However, differences in hamstring strength, bone mineral density, sit-to-stand testing, walking speed, length of hospital stay and need for further inpatient rehabilitation did not reach statistical significance. There were no reported adverse events.ConclusionsThere is insufficient evidence to recommend routine administration of AAS to patients undergoing TKR. However, pilot data suggest that AAS can be administered safely and may improve important postoperative outcome measures. This justifies a randomised trial sufficiently powered to identify between-group differences likely to be of clinical significance.

Total Serum Testosterone and Western Ontario and McMaster Universities Osteoarthritis Index Pain and Function Among Older Men and Women With Severe Knee Osteoarthritis

“…Our findings are consistent with an earlier study describing a nonsignificant inverse association between testosterone level and WOMAC disability among women and WOMAC stiffness among men with symptomatic knee OA age ≥60 years (18). As outlined in the introduction of this article, a potential benefit of testosterone level with regard to pain and disability among patients with severe knee OA could be explained by prior findings supporting a positive association of higher testosterone levels with better muscle strength (39,40) and better muscle function (41) in patients with knee OA. Further, an influence of testosterone on nociceptive processing (19,20) and inflammatory response has been suggested in several studies (7,9–11), all of which concern important pathways in the development of OA (42,43).…”

A study of deformity of osteoarthritis in Indian population

“…Many studies have been published in Indian literature regarding the magnitude of knee deformities, but our study projects large number of cases which can give insight of knee deformities. It is basically characterised pathologically by focal degeneration of articular cartilage, subchondral bone thickening, osteophyte formation and joint deformity [5][6][7] . Due to increasing pain, muscle spasm develops which subsequently causes joint deformities, genu varus being the most common [1] .…”