Perioperative dexamethasone does not affect functional outcome in total hip arthroplasty

Area of Science:

• Orthopaedic Surgery
• Anesthesiology
• Pharmacology

Background:

• Adjuvant treatments are explored in orthopaedic surgery to reduce postoperative pain and nausea/vomiting.
• Dexamethasone is a potential adjuvant, offering antiemetic and opioid-sparing effects in total hip arthroplasty (THA).
• Longer-term effects of dexamethasone on pain, complications, and function post-THA are not well-established.

Purpose of the Study:

• To investigate the longer-term effects of a single preoperative dose of dexamethasone on pain, complications, and function in patients undergoing THA.
• To evaluate the routine use of dexamethasone as part of a multimodal analgesic regimen in low-risk THA patients.

Main Methods:

• A prospective comparative study (Level II evidence) involving 50 patients undergoing elective primary THA under spinal anesthesia.
• Patients were randomized to receive either intravenous dexamethasone (40 mg) or saline placebo, with double-blinding.
• Functional outcomes were assessed using the Harris hip score at 6 weeks and 1 year postoperatively.

Main Results:

• No significant difference in resting pain was observed between the dexamethasone and placebo groups at 6 weeks or 1 year.
• Similar functional outcome scores (total Harris hip score and individual items) were recorded in both groups at all follow-up intervals.
• No adverse events such as wound complications, deep infections, or osteonecrosis were reported in either group at 1-year follow-up.

Conclusions:

• A single preoperative dose of dexamethasone in THA provides immediate antiemetic and opioid-sparing effects.
• The routine addition of dexamethasone does not appear to negatively impact longer-term pain, function, or complication rates.
• Dexamethasone can be recommended as an adjuvant in multimodal analgesia for low-risk THA patients due to its short-term benefits and lack of adverse long-term effects.