The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty

Document Type : RESEARCH PAPER

Authors
Brandon E. Lung
Ryan Le
Maddison McLellan
Kylie Callan
Megan Donnelly
Justin Yi
Paramveer Birring
William C. McMaster
Steven Yang
David H. So
University of California, Irvine Department of Orthopedic Surgery, Orange, CA, USA
10.22038/abjs.2022.65130.3124
Abstract
Objectives: Perioperative dexamethasone is an effective anti-emetic and systemic analgesic in total hip arthroplasty (THA) that may reduce opioid consumption and enhance rapid recovery. However, there is no consensus on the optimal perioperative dosing that is safe and effective for faster rehabilitation and improved pain control while maintaining safe blood glucose levels. Methods: A retrospective review of 101 primary THA patients at a single institution who received perioperative dexamethasone was conducted. Patients were stratified by dexamethasone induction dosage (10 mg as high, <6mg as low) and whether a repeat dose was given 16-24 hours postoperatively. Age, gender, BMI, diabetes status, and ASA were controlled between groups. The pain was evaluated with inpatient morphine milligram equivalents (MME) requirements and visual analog scale (VAS) at 8, 16, and 24 hours postoperatively. Mobility was assessed by inpatient ambulation distance, Boston AM-PAC mobility score, and percentage of gait assistance as determined by a physical therapist. Secondary outcomes included postoperative nausea and vomiting (PONV) limiting therapy sessions, PONV requiring breakthrough anti-emetics, glucose levels, surgical site infection, wound healing complications, and discharge destination. Results: : Compared to patients receiving one dose of high or low dexamethasone, patients receiving two dosages of high-dose dexamethasone had significantly further ambulation distance and lower percentage of gait assistance on postoperative day 2. A generalized linear model also predicted that any repeat dexamethasone, regardless of dosage, significantly improved ambulation distance and gait assistance compared to the one-dose cohort. There was no statistically significant difference between VAS scores, MME requirements, PONV, postoperative glucose levels >200, discharge destination, or risk of infection between groups. Conclusion: A repeat high-dose dexamethasone, the morning after surgery, may improve percentage of gait assistance and ambulation endurance on postoperative day two. There was no risk of uncontrolled glucose levels or infections compared to receiving one dose of dexamethasone at induction. Level of evidence: III
Keywords
Dexamethasone
Peri-operative management
Pain control
Patient outcomes
Total hip arthroplasty
Subjects
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The Archives of Bone and Joint Surgery
Volume 11, Issue 3
March 2023
Pages 188-196

  • Receive Date 28 April 2022
  • Revise Date 19 September 2022
  • Accept Date 21 September 2022