Effect of pre‐operative methylprednisolone on orthostatic hypotension during early mobilization after total hip arthroplasty

Background Orthostatic hypotension ( OH ) and intolerance ( OI ) are common after total hip arthroplasty ( THA ) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post‐operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre‐operative high‐dose methylprednisolone on OH and OI early after THA . Methods Randomized, double‐blind, placebo‐controlled study in 59 patients undergoing elective unilateral THA with spinal anesthesia and a standardized multimodal analgesic regime. Patients were allocated (1 : 1) to pre‐operative intravenous ( IV ) methylprednisolone ( MP ) 125 mg or isotonic saline (C). OH , OI and cardiovascular responses to sitting and standing were evaluated using a standardized mobilization protocol pre‐operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non‐invasively (Nexfin ® ). The systemic inflammation was monitored by the C‐reactive protein ( CRP ) response. Results At 6 h post‐operatively, 11 (38%) versus 11 (37%) patients had OH in group MP and group C, respectively ( RR 1.02 (0.60 to 1.75; P = 1.00)), whereas OI was present in 9 (31%) versus 13 (43%) patients ( RR 0.76 (0.42 to 1.36; P = 0.42)), respectively. At 24 h post‐operatively, the prevalence of OH and OI did not differ between groups, though CRP levels were significantly reduced in group MP ( P < 0.001). Conclusion Pre‐operative administration of 125 mg methylprednisolone IV did not reduce OH or OI compared with placebo despite a reduced inflammatory response.