Study Summary

Ten randomized controlled trials containing a total of 1100 patient knees were included in this meta-analysis comparing peri-operative low-dose dexamethasone administration to placebo in patients undergoing total knee arthroplasty (TKA). Primary outcomes of interest included pain using the visual analogue scale (VAS) at 24 and 48 hours post-surgery, incidence of complications, immediate range of motion (ROM), and incidence of post-operative nausea and vomiting (PONV). Secondary outcomes included the following: total consumption of opioids at 24 and 48 hours, length of hospital stay, and blood glucose levels. Pooled results demonstrated that VAS pain at 24 and 48 hours post-TKA were statistically significantly reduced in the peri-operative dexamethasone group vs placebo (p< 0.001; p=0.002, respectively). Furthermore, pooled active and passive ROM were both statistically significantly improved in the dexamethasone group compared to placebo at 72 hours post-TKA (p<0.001; p=0.001, respectively). In addition, pooled results for the incidence of PONV and total consumption of opioids at 24 and 48 hours post-TKA were both statistically significantly in favour of the dexamethasone group vs placebo (p<0.05 for all). Pooled blood glucose levels were statistically significantly higher in the dexamethasone group at 24 hours follow-up (p<0.001) but not at 72 hours follow-up (p>0.05). Finally, pooled results of length of hospital stay and incidence of complications (i.e., deep vein thrombosis, infection, inadequate wound healing, pulmonary embolism) were not statistically significantly different between the pre-operative dexamethasone group and placebo group (p>0.05 for all).