an elaborate multi-
modal protocol. The
most atypical compo-
nent is intravenous
hydrocortisone,
which we administer
in 3 doses, 8 hours
apart, starting about
an hour before the
surgery.
That concept
stems from studies
of trauma patients
from orthopedic lit-
erature. These
patients have a very
high incidence of fat
embolism, meaning that fat travels from long bone fractures into their
bloodstream and ends up in their lungs, which can not only seriously
compromise recoveries, it can be life-threatening. But it didn't happen
when trauma patients were given hydrocortisone before an operation
and at 2 intervals afterward.
For our bilateral knee patients, we tried the same approach in a ran-
domized trial, and looked for specific inflammatory factors that tend
to occur after a major operation or trauma. The hydrocortisone not
only kept inflammation down, it made the operation less provocative
to the lungs and general system. Patients were able to move their
knees better afterward and needed less pain medication.
O C T O B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 9 3
Dr. Sculco convened a consensus panel of
cardiologists, anesthesiologists, orthopedic
surgeons and others to publish a consensus
statement that details 11 conditions under
which bilateral TKAs are inappropriate.
