Key result
Pre-operative intravenous methylprednisolone (125 mg) did not reduce orthostatic hypotension at 6 hours post-total hip arthroplasty compared with placebo (38% vs 37%; RR 1.02; 95% CI 0.60-1.75; P=1.00).
Why the study?
Does pre-operative intravenous methylprednisolone reduce orthostatic hypotension and intolerance in patients undergoing elective unilateral total hip arthroplasty?
RCT (n=59)
Double-blind
1:1
Does pre-operative intravenous methylprednisolone reduce orthostatic hypotension and intolerance in patients undergoing elective unilateral total hip arthroplasty?
Relative Risk: 1.02 (95% CI 0.6–1.75)
Absolute Event Rate: 38% vs 37%
p-value: p=1.00
Pre-operative high-dose methylprednisolone does not reduce the incidence of orthostatic hypotension or intolerance during early mobilization after total hip arthroplasty.
No support for preoperative methylprednisolone to prevent orthostatic issues after hip arthroplasty; confirms lack of benefit in this RCT.
Background Orthostatic hypotension (OH) and intolerance (OI) are common after total hip arthroplasty (THA) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post‐operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre‐operative high‐dose methylprednisolone on OH and OI early after THA. Methods Randomized, double‐blind, placebo‐controlled study in 59 patients undergoing elective unilateral THA with spinal anesthesia and a standardized multimodal analgesic regime. Patients were allocated (1 : 1) to pre‐operative intravenous (IV) methylprednisolone (MP) 125 mg or isotonic saline (C). OH, OI and cardiovascular responses to sitting and standing were evaluated using a standardized mobilization protocol pre‐operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non‐invasively (Nexfin®). The systemic inflammation was monitored by the C‐reactive protein (CRP) response. Results At 6 h post‐operatively, 11 (38%) versus 11 (37%) patients had OH in group MP and group C, respectively (RR 1.02 (0.60 to 1.75; P = 1.00)), whereas OI was present in 9 (31%) versus 13 (43%) patients (RR 0.76 (0.42 to 1.36; P = 0.42)), respectively. At 24 h post‐operatively, the prevalence of OH and OI did not differ between groups, though CRP levels were significantly reduced in group MP (P < 0.001). Conclusion Pre‐operative administration of 125 mg methylprednisolone IV did not reduce OH or OI compared with placebo despite a reduced inflammatory response.
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Lindberg-Larsen et al. (2018) conducted an RCT in Orthostatic hypotension and intolerance after total hip arthroplasty (n=59). Methylprednisolone vs. Isotonic saline was evaluated on Orthostatic hypotension at 6 hours post-operatively (RR 1.02, 95% CI 0.60 to 1.75, p=1.00). Pre-operative intravenous methylprednisolone (125 mg) did not reduce orthostatic hypotension at 6 hours post-total hip arthroplasty compared with placebo (38% vs 37%; RR 1.02; 95% CI 0.60-1.75; P=1.00).
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