The Efficacy and Safety of Perioperative Glucocorticoid for Total Knee Arthroplasty: A Systematic Review and Meta-analysis

Abstract

Abstract Background: An increasing number of individuals undergo total knee arthroplasty (TKA), which can result in pain, limited motor function and adverse complications such as inflammation and poor rehabilitation. Glucocorticoids have been shown anti-inflammatory and antiemetic effects, but the drugs can also elevate blood glucose levels and increase the risk of wound infection. Thus, it is essential to investigate the efficacy and safety of glucocorticoid usage in TKA. Method: A comprehensive systematic search of PubMed, Medline, EMBASE, Cochrane databases, to identify relevant randomized controlled trials (RCTs) of glucocorticoid application in TKA. The primary outcomes assessed were the postoperative pain assessment. Secondary outcomes included the range of motion in knee joint, levels of inflammatory cytokines, adverse complications, and the length of hospital stay. Results: Thirty-six randomized controlled trials were included in the final analysis. The glucocorticoid group exhibited significant reduction in VAS scores on postoperative days 1, 2 (POD1, 2)and postoperative 3 months (POM3), as well as decreased morphine consumption on POD1 and increased range of motion (ROM) in knee joint on POD1, 3. Additionally, the glucocorticoid group exhibited decreased levels of postoperative inflammatory cytokines and the incidence of PONV along with a shorter length of hospital stay. The blood glucose on POD2 and occurrence of adverse complications were similar between two groups. The periarticular injection analgesia (PIA) group demonstrated lower VAS scores on POD2 and higher plasma CRP levels comparing to the systemic administration group. Conclusion: Glucocorticoid application in TKA can provide anti-inflammatory, analgesic and antiemetic effects, as well as improved range of motion and rehabilitation. Moreover, periarticular injection of glucocorticoids can effectively alleviate pain, while systemic administration can decrease plasma CRP levels after TKA more significantly.