Review Paper
Glucocorticoids in the treatment of joint surgery

Introduction

Daily surgical practice shows many postoperative problems connected with gaining regular range of movement in operated joint. It applies mainly to big joints, especially to knee in rheumatoid arthritis (RA). In rheumatoid arthritis there is a chronic, progressive, inflammatory tissue disorder of unknown origin and in addition to join stiffness, ankylosis, and associated joint deformity, patients may have systemic involvement of the eyes, kidneys, chest, and lungs. Furthermore, it is thought that the autoimmune component of the disease can have significant multi-system effects, including scleritis, pericarditis, pleural effusions, vasculitis, and skin ulceration [1].
In the case of changes related to arthropathic psoriasis or RA with the tendency towards spontaneous ankylosis, the only used surgical procedures are those, which are restricted to arthrolysis – surgical adhesions release [2]. Namely, there are three different means of treatment possible for knee joint stiffness: manual joint mobilization under anesthesia, arthroscopic operation, and ‘‘open arthrolysis’’. Even the most confidently and accurately done; arthrolysis does not ensure the full success. Many patients suffer from big mobility restriction both in flexion and in joint extension. Disadvantageous functional result has occurred also when intra-operative knee mobility has been done [3]. Yercan et al investigated the prevalence of stiffness after total knee arthroplasty, and the results of the treatment options in their practice [4]. The prevalence of stiffness in 1188 posterior-stabilized total knee arthroplasties was 5.3%, at a mean follow-up 31 months postoperatively. The patients with painful stiffness were treated by two modalities: manipulation and secondary surgery. The authors concluded that early manipulation gives better gain of motion than done later, and open arthrolysis does not correct a limited flexion arc, but it does relieve pain. Another orthopedic surgeons Kim et al reviewed the results of 1000 consecutive primary total knee replacements to determine the prevalence of stiffness [5]. They define a stiff knee as one having a flexion contracture of ł15 degrees and/or <75 degrees of flexion. The prevalence of stiffness was 1.3%, at an average of thirty-two months postoperatively. The patients with a stiff knee had significantly less preoperative extension and flexion than did those without a stiff knee....


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