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Meta-Analysis
. 2017 Jun 27;12(1):100.
doi: 10.1186/s13018-017-0601-4.

Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials

Chen Yue  1 , Rong Wei  2 , Youwen Liu  3
Affiliations
Meta-Analysis

Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials

Chen Yue et al. J Orthop Surg Res. .

Abstract

Background: Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty (TKA/THA) is an important and controversial topic. We conducted this systematic review and meta-analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA.

Methods: A comprehensive search was performed on PubMed, OVID, and Web of Science databases, and a systematic approach was carried out starting from the PRISMA recommendations. Relevant randomized controlled trials (RCTs) were selected. The risk of bias was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions version. Data were extracted and meta-analyzed or qualitatively synthesized for all the outcomes.

Results: Data were extracted from 11 trials involving 774 procedures. Meta-analysis showed that high-dose systemic steroid (dexamethasone > 0.1 mg/kg) rather than low dose is effective to reduce postoperative nausea and vomiting and postoperative acute pain (within 24 h). In addition, systemic steroid is associated within faster functional rehabilitation and greater inflammation control. On the other hand, systemic steroid is associated with a higher level of postoperative serum glucose on the operation day. The complications between groups are similarly low.

Conclusions: Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain, high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA. The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control. More large, high-quality studies that investigate the safety and dose-response relationship are necessary.

Keywords: Knee and hip arthroplasty; Rapid recovery; Systemic steroid.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Forest plot of postoperative nausea and vomiting. Abbreviations: 95%CI 95% confidence intervals, df degrees of freedom, Fixed fixed-effects modeling, M-H Mantel-Haenszel
Fig. 3
Fig. 3
Forest plot of hospital length of stay. Abbreviations: 95%CI 95% confidence intervals, df degrees of freedom, Fixed fixed-effects modeling, IV inverse variance
See this image and copyright information in PMC

References

    1. Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004;86-A(5):963–74. doi: 10.2106/00004623-200405000-00012. - DOI - PubMed
    1. Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res. 2006;443:266–72. doi: 10.1097/01.blo.0000188066.01833.4f. - DOI - PubMed
    1. Husted H, Holm G. Fast track in total hip and knee arthroplasty—experiences from Hvidovre University Hospital, Denmark. Injury. 2006;37(Suppl 5):S31–5. doi: 10.1016/S0020-1383(07)70009-8. - DOI - PubMed
    1. Sculco PK, Pagnano MW. Perioperative solutions for rapid recovery joint arthroplasty: get ahead and stay ahead. J Arthroplasty. 2015;30(4):518–20. doi: 10.1016/j.arth.2015.01.036. - DOI - PubMed
    1. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6–10. doi: 10.1093/oxfordjournals.bja.a013383. - DOI - PubMed

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