Perioperative Corticosteroids and Complications after TJA

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.