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Peri-operative steroids reduce pain, inflammatory response and hospitalisation length following knee arthroplasty without increased risk of acute complications: a meta-analysis

  • Davide Previtali
  • Giorgio Di Laura FratturaEmail author
  • Giuseppe Filardo
  • Marco Delcogliano
  • Luca Deabate
  • Christian Candrian
KNEE
  • 83 Downloads

Abstract

Purpose

There is no consensus regarding the risks and benefits of peri-operative steroid supplementation in total knee arthroplasty (TKA). The aim of this meta-analysis is to compare TKA protocols implemented with or without steroids in terms of pain, inflammatory response, hospitalisation length, and complications.

Methods

A systematic literature search was performed on July 2019 in PubMed, Medline, Embase, Web of Science, Cochrane library, and the grey literature for a meta-analysis of RCTs comparing peri-operative analgesia protocols implemented with or without steroids. Sub-analyses considering the administration route, steroid type, and dosage were performed. The inverse variance method and the Mantel–Haenszel test were used for pooling continuous variables and for dichotomous variables, respectively. Risk of bias and quality of evidence were defined according to the Cochrane guidelines.

Results

Twenty articles were included. Steroid supplementation provides significantly lower post-operative pain from day 1 to day 4 (p < 0.05), with less opioid consumption (p = 0.05), less nausea and vomiting (p < 0.05), and greater knee range of motion (p < 0.001), thus resulting in a shorter hospitalisation length (p = 0.01). Moreover, lower C-reactive protein (p < 0.05), and IL-6 (p < 0.05) levels, but a higher blood glucose level at day 1 (p = 0.004), were documented. No significant differences were documented in all the outcomes after 4 days of follow-up. These results were achieved without an increased incidence of complications. According to the results of the sub-analyses, the intravenous administration of 200 steroid equivalents of a long-acting steroid was associated with better results.

Conclusion

Steroid supplementation of peri-operative drug protocols is effective in decreasing post-operative pain, opioid consumption, nausea and vomiting, range of motion limitation, and inflammatory markers without increasing short- and mid-term complications. Although these benefits last only the peri-operative period, steroid supplementation can reduce the length of hospitalisation after TKA.

Level of evidence

Systematic review and meta-analysis, level II.

Keywords

TKA Prosthesis Total knee replacement Steroid Post-operative pain Hospitalisation 

Abbreviations

TKA

Total knee arthroplasty

OA

Osteoarthritis

RCT

Randomised controlled trial

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PROM

Patient reported outcome measures

PONV

Post-operative nausea and vomit

ROM

Range of motion

MD

Mean difference

RR

Risk ratio

IV

Intravenous

POD

Post-operative day

SE

Steroids equivalents

Notes

Acknowledgements

We would like to thank Guido Ascenso for the help with the English version of the manuscript.

Author contributions

DP conceived the methods of the study, performed the database search, the article selection and data extraction processes, performed the statistical analysis and drafted the manuscript. GDLF conceived the methods of the study, performed the database search, the article selection and data extraction processes, and drafted the manuscript. GF conceived the methods of the study, helped with the data extraction process, and drafted the manuscript. LD, MD, and CC helped to draft the manuscript. All authors read and approved the manuscript.

Compliance with ethical standards

Conflict of interest

Dr. Previtali, Dr. Di Laura Frattura, Dr. Deabate and Dr. Delcogliano declare they have no conflict of interest. Dr. Filardo reports institutional support from Finceramica Faenza SPA, Fidia Farmaceutici SPA, CartiHeal (2009) ltd, EON medical SRL, IGEA clinical biophysics, BIOMET, and Kensey nash outside the submitted work. Dr. Candrian reports grants from Medacta International SA, Johnson & Johnson, Lima Corporate, Zimmer Biomet, and Oped AG, outside the submitted work.

Funding

No funding were avaliable for this study.

Ethical approval

This meta-analysis and all the included studies meet all the ethical standards described in the declaration of Helsinki. No ethical commitee approval was required for this study.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Orthopaedic and Traumatology UnitOspedale Regionale di Lugano, EOCLuganoSwitzerland
  2. 2.ATRCIRCCS Istituto Ortopedico RizzoliBolognaItaly

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