Methylprednisolone Taper After Total Knee Arthroplasty: A Prospective Single-Blinded Randomized Trial

The use of short-term postoperative corticosteroid regimens has been reported to improve pain control and decrease opioid consumption following total knee arthroplasty (TKA). The purpose of this study was to evaluate the effect of a methylprednisolone taper (MPT) on reducing patients' subjective pain levels and opioid consumption in the early postoperative period following primary TKA.

This was a prospective single-blinded randomized controlled trial of patients undergoing primary TKA for osteoarthritis. Patients were randomized to receive a standardized multimodal pain control regimen alone or the same regimen with a 6-day oral MPT (i.e., Medrol Dosepak). Patient pain and nausea Visual Analog Scale scores, as well as opioid consumption data, were collected for 7 days, while knee range of motion was collected preoperatively and at the 3-month follow-up visit. An a priori power analysis was conducted, and 69 patients were enrolled from October 2023 to March 2025, with 34 randomized into the control group and 35 into the MPT group.

Patients in the MPT group reported significantly decreased nausea levels on postoperative day 1 (P < 0.05). Daily and cumulative oral morphine equivalents were decreased in the MPT group over the first postoperative week, with a mean cumulative oral morphine equivalent of 95.5 versus 116.9, though this did not reach statistical significance. The majority of patients stopped opioids by day 7 in both groups. Pain scores were lower, but not significantly so, in the MPT group. There were no increased complications seen in the MPT group. Range of motion changes were equivalent between groups.

This randomized controlled trial demonstrated a significant reduction in nausea levels on postoperative day 1 and a nonsignificant trend toward reduced pain and opioid use with a 6-day MPT following primary TKA for osteoarthritis in the context of a multimodal postoperative regimen. Importantly, we observed no increased complications with the use of an MPT.