{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:40:33Z","timestamp":1790617233873,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,3,24]],"date-time":"2018-03-24T00:00:00Z","timestamp":1521849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Orthostatic hypotension (<jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content>) and intolerance (<jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content>) are common after total hip arthroplasty (<jats:styled-content style=\"fixed-case\">THA<\/jats:styled-content>) and may delay early mobilization. The pathology of <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> includes a dysregulated post\u2010operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> could be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre\u2010operative high\u2010dose methylprednisolone on <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> early after <jats:styled-content style=\"fixed-case\">THA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomized, double\u2010blind, placebo\u2010controlled study in 59 patients undergoing elective unilateral <jats:styled-content style=\"fixed-case\">THA<\/jats:styled-content> with spinal anesthesia and a standardized multimodal analgesic regime. Patients were allocated (1 : 1) to pre\u2010operative intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) methylprednisolone (<jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content>) 125 mg or isotonic saline (C). <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> OI<\/jats:styled-content> and cardiovascular responses to sitting and standing were evaluated using a standardized mobilization protocol pre\u2010operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non\u2010invasively (Nexfin<jats:sup>\u00ae<\/jats:sup>). The systemic inflammation was monitored by the C\u2010reactive protein (<jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>) response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 6 h post\u2010operatively, 11 (38%) versus 11 (37%) patients had <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> in group <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content> and group C, respectively (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.02 (0.60 to 1.75; <jats:italic>P<\/jats:italic> = 1.00)), whereas <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> was present in 9 (31%) versus 13 (43%) patients (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.76 (0.42 to 1.36; <jats:italic>P<\/jats:italic> = 0.42)), respectively.<\/jats:p><jats:p>At 24 h post\u2010operatively, the prevalence of <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> did not differ between groups, though <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> levels were significantly reduced in group <jats:styled-content style=\"fixed-case\">MP<\/jats:styled-content> (<jats:italic>P<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pre\u2010operative administration of 125 mg methylprednisolone <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> did not reduce <jats:styled-content style=\"fixed-case\">OH<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> compared with placebo despite a reduced inflammatory response.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.13108","type":"journal-article","created":{"date-parts":[[2018,3,24]],"date-time":"2018-03-24T11:29:28Z","timestamp":1521890968000},"page":"882-892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Effect of pre\u2010operative methylprednisolone on orthostatic hypotension during early mobilization after total hip arthroplasty"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-8477","authenticated-orcid":false,"given":"V.","family":"Lindberg\u2010Larsen","sequence":"first","affiliation":[{"name":"Section for Surgical Pathophysiology 7621 Copenhagen University Hospital Rigshospitalet Copenhagen Denmark"},{"name":"The Lundbeck Foundation Centre for Fast\u2010Track Hip and Knee Arthroplasty Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. B.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Section for Surgical Pathophysiology 7621 Copenhagen University Hospital Rigshospitalet Copenhagen Denmark"},{"name":"The Lundbeck Foundation Centre for Fast\u2010Track Hip and Knee Arthroplasty Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8.","family":"Jans","sequence":"additional","affiliation":[{"name":"The Lundbeck Foundation Centre for Fast\u2010Track Hip and Knee Arthroplasty Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Copenhagen University Hospital, Bispebjerg and Frederiksberg Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Kehlet","sequence":"additional","affiliation":[{"name":"Section for Surgical Pathophysiology 7621 Copenhagen University Hospital Rigshospitalet Copenhagen 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