Comparative clinical efficacy and safety of perioperative systemic glucocorticoids in primary unilateral total hip arthroplasty: a GRADE-assessed meta-analysis of randomized controlled trials.

Study Summary

12 randomized controlled trials including 1128 patients undergoing primary unilateral total hip arthroplasty (THA) were included in this systematic review and GRADE-assessed meta-analysis comparing perioperative systemic glucocorticoids with placebo or standard care. The primary outcome of interest was the postoperative pain. The secondary outcomes of interest were the postoperative nausea and vomiting (PONV), opioid consumption, glycemic control, inflammatory markers, length of hospital stay, functional recovery, and postoperative complications. Systemic glucocorticoids significantly reduced early postoperative pain, although the reduction did not reach the minimal clinically important difference, and substantially decreased PONV, nausea severity, rescue antiemetic use, inflammatory markers, and hospital length of stay without increasing short-term wound complications, infections, or postoperative glucose levels in predominantly non-diabetic patients. Overall, perioperative systemic glucocorticoids appear to be a safe adjunct within multimodal perioperative care for primary unilateral THA, but further high-quality trials are needed to determine the optimal dosing regimen and establish safety in diabetic and other high-risk populations.