We reviewed sixteen studies that evaluated the impact of perioperative dexamethasone on outcomes after TJA.[2–17] Fourteen of the sixteen studies were assessed as high quality and two studies were assessed as moderate quality of evidence. Due to heterogeneity in the dosage, number of doses, frequency, and duration of treatment, a limited number of meta-analyses were performed.
All sixteen studies evaluated the effects of perioperative dexamethasone on postoperative pain. Eleven of the sixteen studies found that perioperative dexamethasone reduces postoperative pain.[5–14,16] Of the nine studies that looked at pain with activity, seven studies reported dexamethasone significantly reduced pain compared to placebo.[6–8,10,11,13,16] At 24 hours postoperatively, six studies found dexamethasone reduced postoperative pain compared to placebo[5,7,9,11–13] while an additional six studies found no difference at the same timepoint.[2–4,8,10,14]
Fifteen studies evaluated opioid consumption within 72 hours after TJA.[2–14] Eleven studies found that administration of perioperative intravenous dexamethasone reduces
postoperative opioid consumption[2,5–9,11–15] while the remaining four studies found no difference compared to placebo.[3,4,10,16] Five studies included in a direct meta-analysis with no heterogeneity (I2 = 0) found that patients who received intravenous dexamethasone required significantly less opioids for breakthrough pain (0.44 relative risk [RR]; 95% confidence interval [CI] 0.28 to 0.68).[7,8,11,12,16]
Thirteen studies evaluated the incidence of postoperative nausea and vomiting among TJA patients who received intravenous dexamethasone.[2,4–12,14–16] Twelve of the thirteen studies found intravenous dexamethasone reduced postoperative nausea and vomiting.[2,4–12,14,16] Nine of these studies included in a direct meta-analysis with moderate heterogeneity (I2 = 48.3%) found that patients who received intravenous dexamethasone had significantly less nausea and vomiting postoperatively compared to placebo (0.43 RR; 95% CI 0.30 to 0.63).[4,6–8,10–12,15,16]
There was limited literature on complications after TJA with intravenous dexamethasone treatment. Only six studies evaluated complications with intravenous dexamethasone and found no difference compared to placebo in rates of superficial and deep infection, gastrointestinal hemorrhage, deep vein thrombosis (DVT), and intramuscular thrombosis.[6,8,11,12,15,16]
Given the limitations of the current literature, it is the opinion of the workgroup that there is insufficient evidence on whether intravenous dexamethasone influences the risk of complications after primary TJA, in particular periprosthetic joint infection and wound healing.
- Backes JR, Bentley JC, Politi JR, Chambers BT. Dexamethasone Reduces Length of Hospitalization and Improves Postoperative Pain and Nausea After Total Joint Arthroplasty A Prospective, Randomized Controlled Trial. J Arthroplast 2013;28:11–7. https://doi.org/10.1016/j.arth.2013.05.041.
- Dissanayake R, Du HN, Robertson IK, Ogden K, Wiltshire K, Mulford JS. Does Dexamethasone Reduce Hospital Readiness for Discharge, Pain, Nausea, and Early Patient Satisfaction in Hip and Knee Arthroplasty? A Randomized, Controlled Trial. J Arthroplast 2018;33:3429–36. https://doi.org/10.1016/j.arth.2018.07.013.
- Kardash KJ, Sarrazin F, Tessler MJ, Velly AM. Single-Dose Dexamethasone Reduces Dynamic Pain After Total Hip Arthroplasty. Anesthesia Analgesia 2008;106:1253–7. https://doi.org/10.1213/ane.0b013e318164f319.
- Koh IJ, Chang CB, Lee JH, Jeon Y-T, Kim TK. Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study. Clin Orthop Relat Res 2013;471:3010–20. https://doi.org/10.1007/s11999-013-3032-5.
- Lei Y, Huang Q, Xu B, Zhang S, Cao G, Pei F. Multiple Low-Dose Dexamethasone Further Improves Clinical Outcomes Following Total Hip Arthroplasty. J Arthroplast 2018;33:1426–31. https://doi.org/10.1016/j.arth.2017.11.057.
- Lei Y, Xu B, Xie X, Xie J, Huang Q, Pei F. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. Int Orthop 2018;42:499–505. https://doi.org/10.1007/s00264-017-3537-8.
- Mathiesen O, Jacobsen LS, Holm HE, Randall S, Adamiec-Malmstroem L, Graungaard BK, et al. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Bja Br J Anaesth 2008;101:535–41. https://doi.org/10.1093/bja/aen215.
- Tammachote N, Kanitnate S. Intravenous Dexamethasone Injection Reduces Pain from Twelve to Twenty-one Hours after Total Knee Arthroplasty: A Double-Blind Randomized Placebo Controlled Trial. J Arthroplast 2019. https://doi.org/10.1016/j.arth.2019.09.002.
- Turner JD, Dobson SW, Weller RS, Russell GB, Henshaw DS. Intravenous dexamethasone fails to prolong psoas compartment block when assessed by objective pinprick sensory testing: a prospective, randomised, dose-dependent, placebo-controlled equivalency trial. Brit J Anaesth 2018;120:308–16. https://doi.org/10.1016/j.bja.2017.11.073.
- Xu B, Ma J, Huang Q, Huang Z, Zhang S, Pei F. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatology Arthrosc 2018;26:1549–56. https://doi.org/10.1007/s00167-017-4506-x.
- Xu H, Zhang S, Xie J, Lei Y, Cao G, Pei F. Multiple Doses of Perioperative Dexamethasone Further Improve Clinical Outcomes After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplast 2018;33:3448–54. https://doi.org/10.1016/j.arth.2018.06.031.
- Yu Y, Lin H, Wu Z, Xu P, Lei Z. Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty—benefit versus harm? Medicine 2019;98:e15852. https://doi.org/10.1097/md.0000000000015852.
- Kim J-K, Ro DH, Lee H-J, Park J-Y, Han H-S, Lee MC. Efficacy of Systemic Steroid Use Given One Day after Total Knee Arthroplasty for Pain and Nausea: A Randomized Controlled Study. J Arthroplast 2019;35:69–75. https://doi.org/10.1016/j.arth.2019.08.026.