High doses of corticosteroids in total hip replacement. Effects on components of coagulation, fibrinolytic, plasma kallikrein-kinin and complement systems

Changes in components of the plasma proteolytic enzyme systems following a standardized musculoskeletal trauma were studied, and the effects of high-dose corticosteroids on these changes were evaluated. Twelve patients who had received an uncemented total hip prosthesis were divided into a steroid and a nonsteroid group. In the early postoperative phase there was reduction of plasma kallikrein, prekallikrein, functional kallikrein inhibition, plasmin, antiplasmin, plasminogen, prothrombin and antithrombin. These reductions closely followed the concentrations of albumin and IgG, and were mostly due to hemodilution, although weak protease activation was assumed to occur. In the high-dose corticosteroid group the values of antithrombin and functional kallikrein inhibition was significantly higher than in the non-steroid group. There was no systemic activation of the complement system following total hip replacement.