Evaluating the Use of Dexamethasone in Diabetic Patients Undergoing Total Joint Arthroplasty: A Systematic Review and...

The American Association of Hip and Knee Surgeons strongly recommends the use of dexamethasone in patients undergoing total joint arthroplasty due to its therapeutic effects. However, use in diabetic patients is controversial due to safety. Therefore, the objective of this study was to determine safety: (1) calculating the postoperative glucose levels; (2) finding the ideal dexamethasone dosing regimen; and (3) reporting complications of dexamethasone administration in diabetic patients undergoing total joint arthroplasty.

A search was performed utilizing the Boolean search phrase "((dexamethasone) AND (diabetic)) AND (((total joint) OR (total knee)) OR (total hip))." Postoperative day (POD) 1, 2, and 3 glucose levels were compared between intervention and control groups with a random-effects proportion meta-analysis weighted for individual study size. Weighted means and SDs were calculated for postoperative glucose levels. Across the 12 studies, 46,685 patients were included, of which 23,892 received at least one dose of dexamethasone.

Dexamethasone administration in diabetic patients resulted in significantly elevated mean glucose levels (mg/dL) on POD1 compared to patients in whom dexamethasone was withheld (170.1 ± 5.3 versus 158.1 ± 5.8, P = 0.0007). However, 95% confidence interval levels were below the 200 mg/dL threshold. Additionally, there were no significant differences on POD2 (P = 0.23) and POD3 (P = 0.16). The risk of infection was not significantly different between the intervention and control groups (risk ratio: 0.82, 95% confidence interval: 0.39 to 1.72, P = 0.61). Due to the heterogeneity of data, and only four studies reporting exact dosages as opposed to ranges, an ideal dosage of dexamethasone could not be found.

Administration of perioperative dexamethasone in diabetic patients appears to be safe. Further investigation is warranted regarding dosage and timing of administration to optimize beneficial effects of dexamethasone while preventing excessive hyperglycemia in diabetic patients.

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