Endocrine and Immune Effects of Dexamethasone in Unilateral Total Knee Replacement

Abstract

The effect of acute pre-surgery dexamethasone treatment on the inflammatory immune and endocrine responses to orthopaedic surgery was investigated. Whole blood samples were obtained before and 5 days after surgery for immune analysis, and serum was obtained before and 6 h, 3 days and 5 days after surgery for endocrine assessment. Dexamethasone did not affect the post-surgery granulocyte response, but inhibited the increase in monocyte count (an average increase of 38.5% was seen in the control group). Peak C-reactive protein concentration (3 days after surgery) was 51.4% lower in the dexamethasone group than in the control group. Dexamethasone had a major effect on cortisol concentrations and the cortisol:testosterone and cortisol: dehydroepiandrosterone ratios, but no effect on anabolic hormone concentrations. In conclusion, acute pre-surgery dexamethasone treatment may have beneficial effects in the post-surgery period, by limiting the extent of systemic inflammation and the cortisol response.

Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

“…They have been used extensively to reduce the stress response following surgery [10]. A single preoperative dose of glucocorticoid limits complement activation and the acute phase response subsequent to hip and knee arthroplasty [5,23]. Patients who were given dexamethasone (16 mg) prior to undergoing knee arthroplasty reportedly had a 50% decrease in peak CRP concentration on the third postoperative day [23].…”

“…The antiinflammatory effects of glucocorticoids in the postoperative period are well known [5,10,23]. A small single dose of dexamethasone reduces C-reactive protein (CRP) levels by 50% three days following total knee replacement [23].…”

“…A small single dose of dexamethasone reduces C-reactive protein (CRP) levels by 50% three days following total knee replacement [23]. There exist various synthetic glucocorticoids that have few mineralocorticoid properties responsible for modulating water and electrolyte balance.…”

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

“…During the past decade, the number of TKAs performed has increased substantially, and future demand is projected to rise rapidly [26,31,35]. However, as a TKA involves extensive bone resection and soft tissue manipulation, patients can experience severe pain during the early postoperative period [13,42,[47][48][49]. Furthermore, many patients experience postoperative nausea and vomiting (PONV) after TKA, owing to not only anesthesia and surgery but also the various agents used for pain control [8,10,20,27].…”

“…Previous studies have found that perioperative use of single, lowdose corticosteroids significantly decreased inflammatory markers after TKA [23,24,49]. However, despite the potential benefits and reported efficacy in numerous surgical procedures, only a few small studies involving less than 25 patients per group evaluated the efficacy and safety of corticosteroids after TKA [15,24,38,40].…”