PMID- 32877755
OWN - NLM
STAT- MEDLINE
DCOM- 20210211
LR  - 20211020
IS  - 1743-9159 (Electronic)
IS  - 1743-9159 (Linking)
VI  - 82
DP  - 2020 Oct
TI  - The optimal dosage, route and timing of glucocorticoids administration for 
      improving knee function, pain and inflammation in primary total knee 
      arthroplasty: A systematic review and network meta-analysis of 34 randomized 
      trials.
PG  - 182-191
LID - S1743-9191(20)30613-0 [pii]
LID - 10.1016/j.ijsu.2020.07.065 [doi]
AB  - PURPOSE: Glucocorticoids are a mainstay to control postoperative pain, 
      inflammation, nausea and vomiting (PONV) in total knee arthroplasty (TKA). 
      Understanding the optimal dose and route of glucocorticoids administration in TKA 
      is of great significance in speedy functional recovery. We aimed to summarize, 
      evaluate and rank order the efficacy of glucocorticoids regimens in TKA. METHODS: 
      Electronic databases (PubMed et al.) were systematically searched from inception 
      up to April 30, 2020. The primary outcomes were visual analogue scale (VAS), 
      range of motion (ROM) and knee society score (KSS). C-reactive Protein (CRP) and 
      PONV were also evaluated. Multivariable Bayesian random effects models were used 
      to synthesize and rank the comparative efficacy of glucocorticoids regimens. 
      RESULTS: A total of 34 eligible randomized controlled trials with 11 different 
      glucocorticoids regimens were assessed. Overall inconsistency and heterogeneity 
      were acceptable. Multiple medium dose perioperative intravenous injection (IV) 
      ranked first in the analgesia network and a single high doses of preoperative IV 
      ranked first in the inflammation and PONV network. There was no statistically 
      significant increase in ROM or KSS in all the glucocorticoid formulations and 
      doses compared with controls on postoperative day 30. CONCLUSIONS: Glucocorticoid 
      multiple intravenous injection was preferable to a single intravenous injection 
      (preoperative and postoperative), periarticular injection and intra-articular 
      injection in analgesia. Based on the available evidence, a medium dose of 
      hydrocortisone of 2-4 mg/kg is optimal.
CI  - Copyright (c) 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights 
      reserved.
FAU - Wu, Limin
AU  - Wu L
AD  - Department of Orthopaedic Surgery, West China Hospital, West China Medical 
      School, Sichuan University, Chengdu, Sichuan Province, 610041, China. Electronic 
      address: wu.l.m@outlook.com.
FAU - Si, Haibo
AU  - Si H
AD  - Department of Orthopaedic Surgery, West China Hospital, West China Medical 
      School, Sichuan University, Chengdu, Sichuan Province, 610041, China. Electronic 
      address: sihaibo1987@163.com.
FAU - Li, Mingyang
AU  - Li M
AD  - Department of Orthopaedic Surgery, West China Hospital, West China Medical 
      School, Sichuan University, Chengdu, Sichuan Province, 610041, China. Electronic 
      address: LiMingyang199606@163.com.
FAU - Zeng, Yi
AU  - Zeng Y
AD  - Department of Orthopaedic Surgery and National Clinical Research Center for 
      Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 
      610041, China. Electronic address: zengyigd@126.com.
FAU - Wu, Yuangang
AU  - Wu Y
AD  - Department of Orthopaedic Surgery, West China Hospital, West China Medical 
      School, Sichuan University, Chengdu, Sichuan Province, 610041, China. Electronic 
      address: wuyuangang23@163.com.
FAU - Liu, Yuan
AU  - Liu Y
AD  - Department of Orthopaedic Surgery, West China Hospital, West China Medical 
      School, Sichuan University, Chengdu, Sichuan Province, 610041, China. Electronic 
      address: yihaoliuyuan@163.com.
FAU - Shen, Bin
AU  - Shen B
AD  - Department of Orthopaedic Surgery, West China Hospital, West China Medical 
      School, Sichuan University, Chengdu, Sichuan Province, 610041, China. Electronic 
      address: shenbin_1971@163.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20200830
PL  - United States
TA  - Int J Surg
JT  - International journal of surgery (London, England)
JID - 101228232
RN  - 0 (Glucocorticoids)
SB  - IM
CIN - Int J Surg. 2021 Mar;87:105888. PMID: 33545370
CIN - Int J Surg. 2021 Aug;92:106030. PMID: 34311125
MH  - *Arthroplasty, Replacement, Knee
MH  - Bayes Theorem
MH  - Glucocorticoids/*administration & dosage
MH  - Humans
MH  - Inflammation/*drug therapy
MH  - Knee Joint/*physiopathology
MH  - Network Meta-Analysis
MH  - Pain Measurement
MH  - Pain, Postoperative/*drug therapy
MH  - Postoperative Nausea and Vomiting/prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Range of Motion, Articular/physiology
OTO - NOTNLM
OT  - Cortisone
OT  - Glucocorticoids
OT  - Inflammation
OT  - Pain
OT  - TKA
OT  - Total knee replacement
EDAT- 2020/09/03 06:00
MHDA- 2021/02/12 06:00
CRDT- 2020/09/03 06:00
PHST- 2020/06/13 00:00 [received]
PHST- 2020/07/31 00:00 [accepted]
PHST- 2020/09/03 06:00 [pubmed]
PHST- 2021/02/12 06:00 [medline]
PHST- 2020/09/03 06:00 [entrez]
AID - S1743-9191(20)30613-0 [pii]
AID - 10.1016/j.ijsu.2020.07.065 [doi]
PST - ppublish
SO  - Int J Surg. 2020 Oct;82:182-191. doi: 10.1016/j.ijsu.2020.07.065. Epub 2020 Aug 
      30.