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Periarticular Analgesic Injection Containing A Corticosteroid Reduces D-Dimer Levels After Total Hip Arthroplasty: Retrospective Comparative Cohort Study
Motoki Sonohata
Saga University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7786-8957
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Of late, periarticular analgesic injection (PAI) has become a common alternative treatment for pain following total hip arthroplasty (THA). However, the systemic effects of PAI containing corticosteroids in patients subjected to THA have not been investigated. This study evaluated the analgesic efficacy and systemic effects of PAI containing a corticosteroid in patients subjected to THA.
Methods: This single-center, retrospective cohort study enrolled patients undergoing unilateral, primary THA. A total of 197 patients (200 hips) were included in the final analyses, with 87 hips in the PAI group and 113 hips in the control group. Numeric Rating Scale (NRS) and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7. Pearson’s correlation coefficients were obtained to assess the correlations between the D-dimer level on POD 7 and each outcome measure on POD 1.
Results: The postoperative white blood cell count (WBC) was significantly higher in the PAI group than in the control group. Postoperative NRS, creatine phosphokinase (CK), and C-reactive protein (CRP) levels were significantly lower in the PAI group. D-dimer levels were significantly lower in the PAI group on POD 7. Postoperative aspartate transaminase (AST), alanine aminotransferase, blood urea nitrogen, and creatinine levels were within reference ranges. D-dimer levels on POD 7 showed a significant negative correlation with WBC on POD 1 (r=-0.4652) and a significant positive correlation with the NRS score and AST, CK, CRP, and D-dimer levels on POD 1 (r=0.1558, 0.2353, 0.2718, 0.3545, and 0.3359, respectively).
Conclusions: PAI containing a corticosteroid may be an effective treatment for pain and inflammation after THA, and it does not seem to cause drug-induced liver or kidney injury. Moreover, corticosteroid PAI can reduce D-dimer levels, which are associated with deep venous thrombosis. Early ambulation may prevent the elevation of postoperative D-dimer levels, and PAI containing a corticosteroid may accelerate early ambulation and reduce the risk of deep venous thrombosis.
Keywords
periarticular analgesic injection, total hip arthroplasty, corticosteroid, anti-inflammation, D-dimer, triamcinolone acetonide
Figure 1
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CURRENT STATUS: Published
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Posted 24 Nov, 2020
Editorial decision: Minor revision
On 24 Nov, 2020
Review #2 received
Received 15 Nov, 2020
Review #1 received
Received 14 Nov, 2020
Reviewer #2 agreed
On 10 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 08 Nov, 2020
Editor assigned
On 01 Nov, 2020
Submission checks complete
On 01 Nov, 2020
Editor invited
On 01 Nov, 2020
This version was not preprinted
Version 1
Posted 18 Sep, 2020
Published
On 06 Jan, 2021
Published
On 06 Jan, 2021
No community comments so far
Editorial decision: Minor revision
On 24 Oct, 2020
Review #2 received
Received 17 Oct, 2020
Review #1 received
Received 11 Oct, 2020
Reviewer #2 agreed
On 30 Sep, 2020
Reviewer #1 agreed
On 27 Sep, 2020
Reviewers invited
Invitations sent on 21 Sep, 2020
Editor assigned
On 08 Sep, 2020
Submission checks complete
On 07 Sep, 2020
Editor invited
On 07 Sep, 2020
First submitted
On 03 Sep, 2020
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Periarticular Analgesic Injection Containing A Corticosteroid Reduces D-Dimer Levels After Total Hip Arthroplasty: Retrospective Comparative Cohort Study
Motoki Sonohata
Saga University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7786-8957
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version (no preprint)
Posted 24 Nov, 2020
Editorial decision: Minor revision
On 24 Nov, 2020
Review #2 received
Received 15 Nov, 2020
Review #1 received
Received 14 Nov, 2020
Reviewer #2 agreed
On 10 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Reviewers invited
Invitations sent on 08 Nov, 2020
Editor assigned
On 01 Nov, 2020
Submission checks complete
On 01 Nov, 2020
Editor invited
On 01 Nov, 2020
This version was not preprinted
Version 1
Posted 18 Sep, 2020
Published
On 06 Jan, 2021
Published
On 06 Jan, 2021
No community comments so far
Editorial decision: Minor revision
On 24 Oct, 2020
Review #2 received
Received 17 Oct, 2020
Review #1 received
Received 11 Oct, 2020
Reviewer #2 agreed
On 30 Sep, 2020
Reviewer #1 agreed
On 27 Sep, 2020
Reviewers invited
Invitations sent on 21 Sep, 2020
Editor assigned
On 08 Sep, 2020
Submission checks complete
On 07 Sep, 2020
Editor invited
On 07 Sep, 2020
First submitted
On 03 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Of late, periarticular analgesic injection (PAI) has become a common alternative treatment for pain following total hip arthroplasty (THA). However, the systemic effects of PAI containing corticosteroids in patients subjected to THA have not been investigated. This study evaluated the analgesic efficacy and systemic effects of PAI containing a corticosteroid in patients subjected to THA.
Methods: This single-center, retrospective cohort study enrolled patients undergoing unilateral, primary THA. A total of 197 patients (200 hips) were included in the final analyses, with 87 hips in the PAI group and 113 hips in the control group. Numeric Rating Scale (NRS) and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7. Pearson’s correlation coefficients were obtained to assess the correlations between the D-dimer level on POD 7 and each outcome measure on POD 1.
Results: The postoperative white blood cell count (WBC) was significantly higher in the PAI group than in the control group. Postoperative NRS, creatine phosphokinase (CK), and C-reactive protein (CRP) levels were significantly lower in the PAI group. D-dimer levels were significantly lower in the PAI group on POD 7. Postoperative aspartate transaminase (AST), alanine aminotransferase, blood urea nitrogen, and creatinine levels were within reference ranges. D-dimer levels on POD 7 showed a significant negative correlation with WBC on POD 1 (r=-0.4652) and a significant positive correlation with the NRS score and AST, CK, CRP, and D-dimer levels on POD 1 (r=0.1558, 0.2353, 0.2718, 0.3545, and 0.3359, respectively).
Conclusions: PAI containing a corticosteroid may be an effective treatment for pain and inflammation after THA, and it does not seem to cause drug-induced liver or kidney injury. Moreover, corticosteroid PAI can reduce D-dimer levels, which are associated with deep venous thrombosis. Early ambulation may prevent the elevation of postoperative D-dimer levels, and PAI containing a corticosteroid may accelerate early ambulation and reduce the risk of deep venous thrombosis.
Figure 1