The Effects of Peri-Operative Dexamethasone on Patients Undergoing Total Hip or Knee Arthroplasty: Is It Safe for Diabetics?

Abstract

Background: Peri-operative dexamethasone has been shown to effectively reduce post-operative nausea and vomiting and aide in analgesia after total joint arthroplasty (TJA); however, systemic glucocorticoid therapy has many adverse effects. The purpose of this study is to determine the effects of dexamethasone on prosthetic joint infection (PJI) and blood glucose levels in patients undergoing TJA. Methods: A retrospective chart review of all patients receiving primary TJA from 2011 to 2015 (n ¼ 2317) was conducted. Patients were divided into 2 cohorts: dexamethasone (n ¼ 1426) and no dexamethasone (n ¼ 891); these groups were subdivided into diabetic and non-diabetic patients. The primary outcome was PJI; secondary measures included glucose levels and pre-operative hemoglobin A1c (A1c) values. Statistics were carried out using logistic and regression models. Results: Of the 2317 joints, 1.12% developed PJI; this was not affected by dexamethasone (P ¼ .166). Diabetics were found to have higher rate of infection (P < .001); however, diabetics who received dexamethasone were not found to have a significantly higher infection rate that non-diabetics (P ¼ .646). Blood glucose levels were found to increase post-operatively, and dexamethasone did not increase this change (P ¼ .537). Diabetes (P < .001) and increasing hemoglobin A1c (P < .001) were also associated with increased serum glucose levels; however, this was not influenced by dexamethasone (P ¼ .595). Conclusion: Although diabetic patients were found to have a higher infection rate overall, this was not affected by administration of intravenous dexamethasone, nor was the post-operative elevation in serum glucose levels. In this study population, peri-operative intravenous dexamethasone did not increase the rate of PJI and was safe to administer in patients undergoing TJA.

The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty

“…Richardson et al [20] found statistical difference neither in prosthetic joint infection (PJI) in patients receiving onetime low-dose dexamethasone before THA and TKA nor was there any significant difference in the timing of infection or the number of subsequent procedures in patients who developed PJI. Godshaw et al [21] found that higher blood glucose levels and higher PJI rates were related not to dexamethasone use but instead to a diagnosis of diabetes. They also found that elevated HbA1c is significantly related to postoperative hyperglycemia [21,22].…”

“…Godshaw et al [21] found that higher blood glucose levels and higher PJI rates were related not to dexamethasone use but instead to a diagnosis of diabetes. They also found that elevated HbA1c is significantly related to postoperative hyperglycemia [21,22]. Although our findings are supportive of prior investigations regarding the effect of dexamethasone on perioperative glucose control, we present useful new data and perspective on what is a practical clinical question as to whether all diabetic patients should receive perioperative dexamethasone.…”

What is the optimal regimen for intravenous dexamethasone administration in primary total hip arthroplasty?

“…[ 5 – 7 ] Its mechanism of action is presumably mediated through a reduction in the production of inflammatory mediators, which may have benefits on pain and functional recovery. [ 8 – 11 ] Nevertheless, owing to its latent side effects, the use of glucocorticoids in perioperative period is still controversial. Several researches have reported latent dexamethasone side effects, for instance, impaired sleep quality, increased infection risk, and elevated blood glucose early after surgery.…”

Evaluating the effects of a total joint education class on patient outcomes

“…Diabetic patients undergoing total joint arthroplasty (TJA) with postoperative hyperglycemia >200 mg/dL have increased the risk of prosthetic joint infection (PJI) (Godshaw, 2019). The CDC guidelines will state that patients with a fasting blood glucose level >200 mg/dL should be considered as uncontrolled diabetics and optimized before elective surgery.…”