Does perioperative systemic steroids administration provide better short-term results in total knee arthroplasty? A systematic review of prospective randomized trials and meta-analysis

INTRODUCTION: A multimodal analgesic approach has become the gold standard for pain control for total knee arthroplasty (TKA). Although the well-known positive effects of steroids for pain management and inflammation in rheumatic pathologies and tendon disorders, the standardized use of in elective primary TKA is still debated. The purpose of this study is to systematically review and meta -analyze prospective randomized trials focused on the perioperative effect of systemic steroid administration in TKA. EVIDENCE ACQUISITION: Placebo -controlled randomized trials (RCT) reporting comparative outcomes of TKA with perioperative systemic administration of corticosteroids were considered eligible. A systematic search was performed in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, Embase, Scopus, Web of Science, ScienceDirect, CINAHL, and LILACS following the PRISMA guidelines. The primary endpoint was to systematically review and meta -analyze the clinical outcomes in patients who were randomized for the systemic steroids administration or placebo in TKA with assessment of pain, range of motion (ROM), opioid consumption, glucose level, wound infections, general complications. EVIDENCE SYNTHESIS: Eight RCTs involving 1.401 patients were included. Peri -operative systemic steroid administration showed a positive effect on pain, ROM, opioid consumption and nausea and vomiting, enhancing postoperative recovery and reducing hospital stay period in patients undergoing TKA without increasing the risk of infection and general complications. CONCLUSIONS: Systemic perioperative steroid administration is effective to improve early outcomes and enhance recovery in patients undergoing TKA. The long-term efficacy and possible complications of multiple and high -dose administration are still uncertain and should be further investigated with long-term RCTs.