Safety Study of High-dose Methylprednisolone in Fast-track Total Knee Arthroplasty
- Conditions
- Infection of Total Knee Joint Prosthesis
- Registration Number
- NCT02019511
- Lead Sponsor
- Rigshospitalet, Denmark
- Brief Summary
It has been shown that a single high dose of steroid before surgery may reduce pain the first 48 hours after insertion of a new joint in the knee, a so called "total knee arthroplasty" (TKA). Consequently, this has been introduced as standard treatment of most patients at several Danish orthopedic departments. Although there are some concerns about the possibility of increased risk of prosthesis infections, this has not been proved in previous studies. However the studies are few, have limited number of patients and are not done using a standardized perioperative set-up.
This study is made to monitor the safety of a single high dose steroid injection before TKA, with regards to prosthesis infection within one year of surgery.
We hypothesize that there will be no increase in infections in patients receiving steroid injection before TKA compared to a historical cohort of patents who did not receive a steroid injection before their TKA.
- Detailed Description
In order to reduce pain intensity as much as possible after surgical procedures, modern multimodal analgesic strategies using different analgetics targeting different mechanism of the pain reception system are used. At the same time this may reduce the use of opioids, which commonly cause sideeffects such as nausea, vomiting, obstipation,urinary retention, itching, respiratory suppression and sedation.
In spite of the use of a wide perioperative multimodal analgesia, pain after total knee arthroplasty (TKA), is stil a considerable clinical problem and need for optimisation of the immediate postoperative pain treatment. There is evidence that "high"dose glucocorticoids administered preoperatively reduces the level of pain and the use of opioids after surgery. A recent review did not give cause for concern regarding use of glucocorticoids in TKA,but found that data on longterm safety aspects are lacking, why no recommendations could be made.
As the limited evidence presently points to af benefit of glucocorticoids without serious side effects, the treatment has been introduced as standard treatment in TKA at several of the departments participating in the Lundbeck Foundation Centre for fast-track Hip and Knee Replacement collaboration.
This study is made to monitor the safety of high dose steroid injection before TKA, with regards to prosthesis infection within one year of surgery.
We hypothesize that there will be no increase in infections in patients receiving steroid injection before TKA compared to a historical cohort of patents who did not receive a steroid injection before their TKA.
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Patients scheduled for primary unilateral elective TKA and no contraindications for high-dose Methylprednisolone preoperatively
- Danish Social security number
One of the following contraindications for Methylprednisolone:
- Allergy against Methylprednisolone.
- Currently in systemic treatment with glucocorticoid
- Current gastric ulcer
- Insulin dependent diabetes mellitus
Further contraindications are at the discretion of the individual department/surgeon. The cohort without preoperative Methylprednisolone treatment will be followed as a separate cohort to identify potential selection bias.
- Citizens without Danish social security number are not eligible for this study as follow-up is not possible.
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method prosthesis related infections within 1 year after TKA 1 year Causes if infection are subdivided into the following:
1. Deep prosthesis related infection
2. Superficial infection (defined as surgery verified infection above level of the fascia)
3. Clinical / paraclinical suspicion of infection only treated with intravenous antibiotics (no surgical procedure)
4. Possible infection, but no clinical/paraclinical suspicion of infection, why the patient is discharged without intravenous antibiotic treatment/surgery.
5. Surgical wound revision (no clinical/paraclinical suspicion of infection)
6. Surgical knee manipulation due to limited range of movement (no clinical/paraclinical suspicion of infection).
7. Surgery due to aseptic non-traumatic loosening of the knee.
8. Surgery due to traumatic loosening of the knee
- Secondary Outcome Measures
Name Time Method Frequency and cause of hospital stay >4 days primary admission Patients admitted for \>4 days will have their discharge files reviewed with regards to causes of this prolonged" stay. This in accordance with the method used in the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement registry trials (Clinicaltrials.gov identifier:NCT01515670)
Frequencies and causes of readmissions to orthopedic departments 12 months after TKA. 1 year These will be found through review of medical files and classified appropriately into broad categories depending on data. Detailed information on each case will be recorded
Frequency and causes of 90 days readmissions 90 days after surgery These will be found through review of medical files and defined as readmission possibly related to surgery and with overnight stay in hospital. These will be classified according to the method used in the ongoing trials in the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement registry (Clin.trials ID:NCT01515670)
mortality 90 days and 1 year Incidence of 90 days and 1 year mortality will be reported
Trial Locations
- Locations (7)
Gentofte University Hospital
🇩🇰Gentofte, Denmark
Farsoe Hospital
🇩🇰Farsoe, Judland, Denmark
Aarhus University Hospital
🇩🇰Aarhus, Judland, Denmark
Sydvestjydsk Sygehus
🇩🇰Grindsted, Judland, Denmark
Holstebro Hospital
🇩🇰Holstebro, Judland, Denmark
Vejle Hospital
🇩🇰Vejle, Judland, Denmark
Viborg Hospital
🇩🇰Viborg, Judland, Denmark