2025 AAOS Annual Meeting: What is the Safest and Most Effective Dose of IV Dexamethasone in TKA? A Multicenter Randomized Controlled Trial

Four hundred and four patients undergoing inpatient primary TKA were randomized to receive either 4 mg (n=138), 8 mg (n=137), or 16 mg (n=129) of IV dexamethasone intraoperatively. The primary outcome of interest was opioid consumption measured in morphine milligram equivalents (MME). Secondary outcomes included pain scores, nausea scores, vomiting episodes, sleep duration, and glucose levels on postoperative day (POD) 1. Outcomes were assessed for up to 7 days postoperatively. Overall, the results of the study revealed that the 16 mg group had lower opioid consumption on POD1 and fewer vomiting episodes, but no significant differences in cumulative 48-hour opioid consumption (p=0.24), pain scores with activity, or 90-day complication rates between groups. The 8 mg group demonstrated the lowest glucose levels at 48 hours. These findings suggest that while 16 mg of dexamethasone provides early benefits in reducing opioid use and vomiting, overall outcomes are similar among all doses beyond the first 24 hours.