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Published on: January 4, 2019
Outcomes Following Supplementary Oral Methylprednisolone Pack After Outpatient Total Knee Arthroplasty: A Matched
Alan D Lam1, Spencer R Foreman2, Stuart J Davidson3
1Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Background:
The growing expansion of outpatient total knee arthroplasty (TKA) and emphasis on multimodal pain control to reduce opioid consumption are essential in optimizing perioperative care. This study aimed to assess postoperative outcomes when prescribing a supplemental oral methylprednisolone after primary TKA.
Methods:
This retrospective study included 366 consecutive patients who underwent primary TKA for end-stage osteoarthritis at an outpatient specialty hospital. Patients were propensity score matched according to specific patient comorbidities at a 1:2 ratio (122:244 case:control) based on whether they received oral methylprednisolone at discharge. The methylprednisolone group included 16 (13.1%) patients who had type II diabetes versus 45 (18.4%) in the control group (P = 0.254). Exposure assignment was time-based, with all patients prescribed the methylprednisolone pack following a specific date. Postoperative 90-day outcomes and additional opioid consumption measured in morphine milligram equivalents (MMEs) were compared.
Results:
Postoperative complications (4.9 versus 1.6%, P = 0.090), readmissions (2.5 versus 3.7%, P = 0.758), and revisions for periprosthetic joint infection (0 versus 1.2%, P = 0.306) did not differ significantly between the oral methylprednisolone and control groups. Patients who received oral methylprednisolone were discharged the same day more often (54.9 versus 31.1%, P < 0.001), but underwent more subsequent manipulations under anesthesia (5.7 versus 1.2%, P = 0.018). The mean MME consumption was not reduced at the 0 to 14 (383 versus 417 MMEs; P = 0.535) or 15 to 30 (422 versus 445 MMEs; P = 0.954) postoperative day intervals.
Conclusions:
Oral methylprednisolone appeared safe in this retrospective study as part of a multimodal regimen following outpatient primary TKA. Although corticosteroid use did not reduce opioid consumption and was associated with higher manipulation rates, larger prospective studies are warranted to clarify these findings. Considering the small overall sample, we recognize that the data are fragile and should not be overinterpreted.
