Related Experiment Video
Updated: Sep 16, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Comparative efficacy of two-dose versus three-dose perioperative intravenous dexamethasone in total knee
Pronay Biswas1, Sai Surya Dinesh Pydi1, Deepak Kumar1
1Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Background:
Dexamethasone is an established adjunct in multimodal perioperative analgesia following total knee arthroplasty (TKA). While its superiority over placebo is well documented, the optimal number of perioperative doses remains undefined. This randomised controlled trial compared the efficacy and safety of two-dose versus three-dose perioperative intravenous dexamethasone in patients undergoing primary TKA, using a pre-specified equivalence framework.
Methods:
A prospective, double-blinded, randomised controlled trial was conducted at a tertiary-care teaching hospital in northern India (October 2023-August 2024; CTRI/2023/09/075789, prospectively registered September 2023). One hundred fifty patients with Kellgren-Lawrence grade 3-4 knee osteoarthritis undergoing primary unilateral TKA were randomised to Group I (two-dose: 8 mg IV dexamethasone at induction and 24 h; n = 75) or Group II (three-dose: 8 mg IV at induction, 24, and 48 h; n = 75). The pre-specified primary endpoint was static Visual Analogue Scale (VAS) pain score at postoperative day 3 (POD3), with an equivalence margin of ±1.0 cm. Secondary outcomes included VAS at all time points, Oxford Knee Score (OKS), range of motion (ROM), rescue analgesia, hospital stay, and complications.
Results:
Groups were comparable at baseline (p > 0.05). At POD3, mean VAS was 4.16 ± 0.77 cm (Group I) versus 4.22 ± 0.82 cm (Group II) (mean difference 0.06 cm; 95% CI -0.17 to 0.29; p = 0.666), within the equivalence margin. No significant differences existed at any secondary time point. At 3 months, OKS was 35.79 ± 2.89 versus 35.63 ± 3.07 (mean difference 0.16; 95% CI -0.80 to 1.12). Complication rates were equivalent (5.3% vs. 8.0%; p = 0.743). No deep infection, thromboembolism, or clinically significant hyperglycaemia occurred in either group.
Conclusion:
Two-dose and three-dose perioperative intravenous dexamethasone demonstrate equivalent analgesic efficacy and functional outcomes following primary TKA. The two-dose regimen is preferred, achieving full benefit while minimising corticosteroid exposure.
Trial Registration:
CTRI/2023/09/075789; prospectively registered September 2023.