Oral Dexamethasone Versus Methylprednisolone Taper for Postoperative Pain and Recovery After Total Knee Arthroplasty

Systemic corticosteroids are playing an increasingly important role in elective total knee arthroplasty (TKA) to aid in postoperative recovery. Corticosteroids reduce inflammation that can cause pain, limit range of motion (ROM), and prolong narcotic use following TKA. Dexamethasone and methylprednisolone are corticosteroids used perioperatively during TKA, but, to our knowledge, a comparative analysis assessing pain and narcotic use has not been done. We sought to determine if a difference exists between these two medications in reducing pain and narcotic usage while also assessing clinical outcomes and complications.

A nonrandomized prospective cohort study was performed of 350 patients undergoing primary unilateral TKA; 200 patients received an oral dexamethasone, and 150 patients received an oral methylprednisolone taper. The primary outcome measures included pain levels and narcotic consumption recorded by patients over the first 30 days after surgery. Pain scores were implemented utilizing the visual analog scale. Narcotic usage was converted to oral morphine milligram equivalents (MMEs). Lengths of hospital stay, knee ROMs, complications, and hospital readmissions were collected.

Patients taking methylprednisolone reported significantly lower pain than patients taking dexamethasone on postoperative days three to seven and nine (all P < 0.05), with no significant differences through day 30. There were no statistically significant differences in MMEs between groups during the first postoperative month. There were no differences in lengths of stay, ROMs, complications, or hospital readmissions.

A novel prospective study is presented comparing dexamethasone versus methylprednisolone, assessing narcotic usage and pain scores following TKA. Patients who received methylprednisolone taper reported statistically significantly lower postoperative pain scores compared to those receiving dexamethasone. Narcotic MMEs and complication rates were similar. Methylprednisolone demonstrated similar clinical outcomes and may be preferred for its more controlled tapering profile and greater ease of prescription and patient compliance than dexamethasone.