Effect of Systemic Corticosteroids on Pain Control After Total Knee Arthroplasty

Reducing pain is the most important goal of total knee arthroplasty (TKA). 

The present study aimed to evaluate the effect of systemic corticosteroids on pain control after TKA.

The present study was performed as a randomized controlled clinical trial study on 75 patients. Patients were randomly assigned to three groups (n=25): the dexamethasone (Dex) group received Dex 8 mg/IV at three times (24 mg), the Met group received methylprednisolone  (Met)125 mg/IV, and the control group received isotonic fluid IV (placebo). Primary outcomes included knee nausea, vomiting, and pain 4, 12, and 24 hours after surgery. The pain was assessed using the visual analog scale. Also, patients’ performance indices were evaluated based on the Western Ontario and McMaster universities osteoarthritis (WOMAC) index after surgery.

The mean scores of pain, 4, 12, and 24 h after surgery in the Dex and Met groups were significantly lower than the placebo group (P<0.001). The mean score of WOMAC and subscales in the Dex, Met, and placebo groups was not significantly different. Postoperative nausea was reduced significantly in the Dex group (P=0.002).

This study shows that administering 24 mg Dex or 125 mg Met significantly reduces pain and nausea 6, 12, and 24 hours after TKA. The effect of Met is significantly less than Dex in controlling pain and nausea. In contrast, Dex and Met had no impact on improvement based on the WOMAC index in patients after TKA.