The Balancing Act of the Inflammatory Cascade After Bilateral Total Knee Arthroplasty

The surgical community does not fully understand the effects of the inflammatory cascade that follow any major surgery, including total knee arthroplasty. Greater surgical insults, such as bilateral total knee arthroplasty, can shift an initial reparative process into a catabolic cascade with ensuing negative clinical sequelae. High levels of inflammatory markers such as interleukin-6 (IL-6) have been associated with extreme reactions, such as fat embolism syndrome and acute respiratory distress syndrome. Management of this inflammatory cascade and its sequelae has already altered current treatment practices, for example, within orthopaedic traumatology. This well-designed study and its prequel were performed to quantitate, and further our understanding of, the physiologic effects of perioperative systemic corticosteroids on the inflammatory response and recovery after bilateral total knee arthroplasty. The safety profile of bilateral total knee arthroplasty remains an unresolved topic of continued investigation. A higher risk of cardiac and pulmonary complications and increased mortality have been cited after bilateral total knee arthroplasty performed during a single anesthetic session, which understandably has been shown to markedly increase the amount of marrow contents …