Summary

Periarticular local steroid injection in TKA suppress the systemic inflammatory response and reduce the general hypercoagulable state

Abstract

Background

Postoperative venous thromboembolism (VTE) is a well-recognized complication after total knee arthroplasty (TKA). Inflammation is known to initiate the coagulation cascade, contributing to a hypercoagulable state after the operation. Intraoperative local periarticular corticosteroid injection reduces local inflammation at the operative site. The purpose of this study was to assess the effect of periarticular local steroid injection on serum level of D-dimer, fibrin degradation products mediated by activated plasmin, indicating the development of a thrombus and level of C-reactive protein (CRP), a marker of inflammation.

Methods

This retrospective cohort study was conducted in 360 consecutive patients who underwent primary TKA between April 2015 and March 2017. Of the patients, 163 received periarticular corticosteroid injection (injection group). As controls, we selected 197 sequential patients who did not receive periarticular injection between April 2015 and March 2016. D-dimer and CRP levels were measured on postoperative day 7.

Results

The mean CRP level in the injection group was significantly lower than that in the control group (1.42±1.3 mg/dL vs 4.62±3.5 mg/dL, p<0.0001) at postoperative day 7. The mean D-dimer level in the injection group was significantly lower than that in the control group (7.5±2.8 µg/mL vs 11.4±4.7 µg/mL, p<0.0001) at post-operative day 7.

Conclusions

Periarticular local steroid injection decreased serum D-dimer levels associated with a decreased CRP level after TKA. This mechanism is interpreted to succeed in suppressing the systemic inflammatory response following surgical stress and reducing the hypercoagulable state after TKA.