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Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty

  • Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting. A small single preoperative dose of dexamethasone, as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty (THA), provides antiemetic and opioid-sparing effects but the longer-term effects on pain, complications, or function are not known. We therefore asked whether such a routine would affect longer-term pain, complications, or function. Fifty patients undergoing elective primary THA using spinal anesthesia were initially randomized to receive either dexamethasone (40 mg intravenous) or saline placebo. The patients, anesthesiologists, nurses, and research coordinators were blinded to the study arms. The functional outcome was measured using the Harris hip score. Outcomes were assessed 6 weeks and 1 year postoperatively. We observed no difference in resting pain between the two groups at either time period. Both groups had similar functional outcome scores for the total Harris hip score and individual scoring items at each followup interval. There were no wound complications, deep infections, or osteonecrosis in the contralateral hip at 1-year followup. We recommend the addition of a small single preoperative dose of dexamethasone to a comprehensive multimodal analgesic regimen in low-risk patients given its immediate antiemetic and opioid-sparing effects, and absence of subsequent effects.

Level of Evidence: Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Alain Petit for his help in preparing the manuscript, and Maricar Alminia and Laura Des Rosiers for their help in administration of the questionnaires and recording the clinical data.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Canada

    Stephane G. Bergeron MD

  2. Department of Anesthesia, SMBD-Jewish General Hospital, Montreal, Canada

    Kenneth J. Kardash MD

  3. Department of Orthopaedics, SMBD-Jewish General Hospital, Room E-003, 3755, Chemin de la Côte Ste-Catherine, Montreal, QC, H3T 1E2, Canada

    Olga L. Huk MD, MSc, David J. Zukor MD & John Antoniou MD, PhD

Authors
  1. Stephane G. Bergeron MD
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  2. Kenneth J. Kardash MD
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  3. Olga L. Huk MD, MSc
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  4. David J. Zukor MD
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  5. John Antoniou MD, PhD
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Corresponding author

Correspondence to John Antoniou MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Bergeron, S.G., Kardash, K.J., Huk, O.L. et al. Perioperative Dexamethasone Does Not Affect Functional Outcome in Total Hip Arthroplasty. Clin Orthop Relat Res 467, 1463–1467 (2009). https://doi.org/10.1007/s11999-009-0733-x

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  • DOI: https://doi.org/10.1007/s11999-009-0733-x

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