Result of Total Knee Arthroplasty in Pre-operative Adreanal Insufficiency Patients.
Kim KK; Lee WS; Bae IT; Cho SJ; Kim YS; Jo IH; Cho SK
Journal of Korean Orthopaedic Research Society (대한정형외과연구학회지)
Journal of Korean Orthopaedic Research Society (대한정형외과연구학회지), Vol.15(1) : 26~31, 2012
PURPOSE: The purpose of this study is to investigate to effect of adrenal insufficiency on the results of TKA. MATERIALS AND METHODS: A total of 89 patients (89 knees) treated with TKA from March, 2008 to October, 2008 were enrolled in this study. Levels of serum cortisol and adrenocorticotropic hormone (ACTH) were checked preoperatively. Hydrocortisone 50~75 mg was injected to adrenal insufficient group at 7:00 AM and 4:00 PM on operative day and the following day. We evaluated the range of motion, the knee society knee score and function score at preoperatively and 2 years follow up, and compared the results between non-adrenal insufficiency group (NAI) and adrenal insufficiency group (AI). RESULTS: Cortisol and ACTH levels were reduced in 36 of 89 patients. All of 36 patients of low cortisol level do not stimulated in ACTH stimulation test. In the adrenal insufficiency group the knee society score (KSS) improved from 49.8 to 86.8 and the knee society functional score (KSFS) from 42.6 to 89.5 at 2 years follow-up. In the control group KSS rose from 51.9 to 84.3 and KSFS from 49.4 to 88.6 during the same period. In adrenal insufficient patients, there were no postoperative complication to include mortality, infection, periprosthetic fracture except skin lesions during operation or postoperatively. There was a case of rupture of quadriceps tendon on the 10th postoperative day which was treated with primary repair. CONCLUSION: Based on our study, there was no increased operative and postoperative complications except skin lesions and 1 case quadricepse tendon rupture in patients with adrenal insufficiency group.