Awarded Study Seeks to Find if Oral Dexamethasone Following TKA Reduce Pain Scores
For Immediate Release
November 17, 2022
Dallas, TX – A presentation at the 2022 AAHKS Annual Meeting examined if oral dexamethasone has been shown to reduce pain in total knee arthroplasty (TKA) beyond a single preoperative dose, and extended duration of steroid use has precedent for nausea prevention during some chemotherapy regimens. This double-blind, randomized, placebo-controlled trial investigates the postoperative effects and safety of oral dexamethasone as a potential augment to multimodal use in outpatient knee arthroplasty.
The study received the AAHKS Clinical Research Award during the 2022 Annual Meeting. This award is given annually in recognition of an outstanding clinical paper in the field of hip and knee arthroplasty.
Primary author Jonathan H. Shaw, MD and co-authors Luke D. Wesemann, BS, Trevor R. Banka, MD, Wayne T. North, MD, Michael A. Charters, MD and senior author Jason J. Davis, MD prospectively randomized 109 consecutive patients undergoing primary TKA at one institution. Patients were assigned to one of two groups: Group A (57 patients) received 4 mg of dexamethasone by mouth twice per day, starting postoperative day (POD), one for four days and Group B received placebo capsules.
Researchers discovered that patients who received dexamethasone had statistically significant decrease in VAS scores when averaging POD 1-4 (p=0.01). The average VAS scores amongst individual days were significantly lower with dexamethasone on POD 2-4. While taking dexamethasone, morning and midday VAS scores were significantly lower. There was no difference between the groups with nausea or vomiting, 90-day complications, ability to walk with/without assistance, difficulty sleeping, and early patient reported outcomes.
The researchers found that this double-blind, randomized, placebo-controlled trial demonstrated that oral dexamethasone following primary TKA reduces pain scores postoperatively when added to a multimodal pain control regimen and this stands as a beneficial and safe option in ambulatory surgery where patients are unable to receive the traditional postoperative intravenous dose of dexamethasone.
“With the recent push to same day discharge in total joint arthroplasty, surgical teams have had to optimize their enhanced recovery after surgery protocol. Preoperative and postoperative intravenous dexamethasone has been a subject of interest in orthopedics over the recent years because of its benefit with postoperative pain and nausea. Because of this study the HFHS arthroplasty team has implemented an oral dexamethasone protocol to the postoperative orders after primary TKA. There is still plenty of research to be done on this topic,” said Jonathan H. Shaw, MD.
About the American Association of Hip and Knee Surgeons
Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education, advocacy, research and outreach. AAHKS has a membership of over 4,600 surgeons and other hip and knee health care professionals.