| Objective: To investigate the effect of different doses of dexamethasone on related clinical indicators after primary unilateral total hip arthroplasty(Total Hip Arthroplasty,THA)and primary unilateral total knee arthroplasty(Total Knee Arthroplasty,TKA).To analyze its clinical significance and provide more reference for the further promotion of the clinical application of dexamethasone in early enhanced recovery after total joint arthroplasty(TJA).Methods: According to the inclusion and exclusion criteria,120 patients who were diagnosed with osteoarthritis/femoral neck fracture/femoral head necrosis and accepted THA/TKA in our hospital from March 1,2020 to September 30,2021 were taken into this research.According to the different doses of dexamethasone used in the perioperative period,patients were divided into three groups: A(control group),B(post-operative 10 mg additional group),and C(post-operative additional 20 mg group).Every group was divided in two subgroups based on the different way of surgery.The basic information and the incidence of perioperative complications of the patients were recorded,and the patients’ HGB and WBC,ESR,CRP,IL-6,PCT,VAS(resting,exercise),quadriceps muscle strength,and ROM were detected and recorded before operation,24 hours,48 hours,and 72 hours after operation.Using repeated measures statistical methods(two-factor repeated measures analysis of variance and nonparametric test),the hip and knee subgroups were compared between groups and within groups to analyze the effect of dexamethasone on the above indicators and evaluate their clinical effects.Results:(1)There was no significant difference in basic data among the groups(P>0.05);(2)After total joint arthroplasty,the HGB continued to decrease with time.(Time effect < 0.001).There was no significant difference in the HGB of each group before surgery and the first 3 days after surgery(P > 0.05);(3)The WBC count of each group increased first and then decreased,reached the peak at 24 h after TJA,then began to decline.The WBC count of the two experimental groups was significantly higher than that of the control group at 48 hours after TKA(P<0.05).The WBC count of the two experimental groups was significantly higher than that of the control group at 24 hours after THA(P<0.05);(4)The erythrocyte sedimentation rate of each group continued to increase within 72 hours after TKA,and at 24 h after operation,the erythrocyte sedimentation rate of the two experimental groups was significantly lower than that of the control group(P<0.05).The erythrocyte sedimentation rate of each group showed a continuous increase trend within 72 hours after THA,and the erythrocyte sedimentation rate of the two experimental groups were significantly lower than that of the control group at the first 72 hours after THA(P<0.05);(5)CRP in the control group after THA continued to increase within 72 hours after operation.The CRP of patients in the two experimental groups increased slowly at 24 hours after operation,increased rapidly and reached the peak at 48 hours after operation,and then began to decline.At 48 h and 72 h after operation,the CRP of the two experimental groups was significantly lower than that of the control group(P<0.05).The change trend of CRP after THA was the same as that after TKA,showing a trend of first increasing and then decreasing.All three groups increased rapidly and reached the peak at 48 h after operation,and then began to decrease.At 48 h and 72 h after operation,CRP in the two experimental groups was significantly lower than that in the control group(P<0.05);(6)IL-6 increased first and then decreased after TKA,and IL-6 of all three groups increased substantially at 24 h after operation.IL-6 in knee A group and knee B group reached the peak at 48 h after operation,and the knee C group reached the peak at 24 h after operation.The IL-6 in all groups was significantly higher than that before the operation within 72 hours(P<0.05),and the IL-6 in the two experimental groups was lower than that in the control group at the first 72 hours after the operation(P<0.05).After THA,except for the time to reach the peak,the change trend and inter-group differences of IL-6 were as same as those after TKA,showing a trend of increased first and then decreased.IL-6 in all the groups showed a significant increase at24 h after surgery.IL-6 in the control group reached the peak at 24 hours after operation,and then began to decline.IL-6 in the two experimental groups reached the peak at 48 hours after operation,and then began to decline.IL-6 in each group was significantly higher at first 72 hours after operation than that before operation(P<0.05),and IL-6 in the two experimental groups was lower than that in the control group at the first 72 hours after operation(P<0.05);(7)After TKA,the PCT of the three groups showed a trend of increased first and then decreased,and there was no significant difference in the PCT between the experimental group and the control group at 24 h after operation(P>0.05).PCT in the two experimental groups were higher than that of the control group at 48 h and 72 h after operation.After THA,the PCT of the three groups also increased first and then decreased.There was no significant difference in PCT between the three groups before surgery and at 24 h,48h,and 72 h after surgery(P>0.05);(8)There was no significant difference in rest pain between the three groups before surgery and at 24 h,48h,and 72 h after surgery(P>0.05).At 24 h after TKA,the exercise pain was the highest.At first 72 hours after surgery,the exercise pain of the two experimental groups was significantly lower than that of the control group(P<0.05).The exercise pain of the patients in the two experimental groups was significantly lower than that of the control group at 24 h after the operation(P<0.05),and there was no significant difference in the exercise pain of the three groups at 48 h after the operation.(P>0.05),at 72 hours after operation,the exercise pain of hip C group was lower than that of hip group A(P<0.05);72 hours after TKA Patients in knee group C consumed less opioids than those in knee group A and knee B(P>0.05);(9)There was no significant difference in quadriceps muscle strength at each time point before operation and within 72 hours after operation in each group.(P>0.05);there was no significant difference in the range of motion of the knee joint between the three groups before TKA and before discharge of hospital(P>0.05);(10)The incidence of perioperative complications and length of stay(LOS)in each group after TJA had no significant difference(P>0.05).Conclusion: Short-term intravenous dexamethasone in the perioperative period of TJA does not increase the incidence of complications,although there is no significant difference in quadriceps femoris muscle strength,ROM,blood volume control and LOS.However,it can significantly increase the white blood cell count after surgery,reduce the levels of inflammatory factors such as IL-6,ESR,and CRP,and reduce the pain score of exercise.Compared with 10 mg dexamethasone,20 mg dexamethasone can reduce postoperative exercise pain after THA and opioid analgesic use after TKA.Therefore,it is recommended that 10-20 mg of dexamethasone be administered intravenously in the perioperative period of total joint arthroplasty to speed up the recovery process of postoperative patients. |
PDF Full Text Request