Evaluating the Use of Dexamethasone in Diabetic Patients Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-analysis

Daniel Razick; Muzammil Akhtar; Ubaid Ansari; Nabeal Dean; Maaz Azim; Mustafa Jundi; Zachary C Lum

doi:10.1016/j.arth.2024.12.018

Evaluating the Use of Dexamethasone in Diabetic Patients Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-analysis

J Arthroplasty. 2024 Dec 18:S0883-5403(24)01320-2. doi: 10.1016/j.arth.2024.12.018. Online ahead of print.

Authors

Daniel Razick¹, Muzammil Akhtar², Ubaid Ansari², Nabeal Dean², Maaz Azim², Mustafa Jundi³, Zachary C Lum⁴

Affiliations

¹ College of Medicine, California Northstate University, 9700 W Taron Dr, Elk Grove, CA 95757. Electronic address: dirazick@gmail.com.
² College of Medicine, California Northstate University, 9700 W Taron Dr, Elk Grove, CA 95757.
³ School of Medicine, University of California at Davis, 4610 X St, Sacramento, CA 95817.
⁴ Department of Orthopaedic Surgery, University of California at Davis, 4301 X St., Sacramento, CA 95817.

PMID: 39706354
DOI: 10.1016/j.arth.2024.12.018

Abstract

Background: The American Association of Hip and Knee Surgeons (AAHKS) strongly recommends the use of dexamethasone in patients undergoing total joint arthroplasty (TJA) due to its therapeutic effects. However, use in diabetic patients is controversial due to safety. Therefore, the objective of this study was to determine safety: (1) calculating the post-operative glucose levels; (2) finding the ideal dexamethasone dosing regimen; and (3) reporting complications of dexamethasone administration in diabetic patients undergoing TJA.

Methods: A search was performed utilizing the Boolean search phrase "((dexamethasone) AND (diabetic)) AND (((total joint) OR (total knee)) OR (total hip))." Postoperative day (POD) one, two, and three glucose levels were compared between intervention and control groups with a random effects proportion meta-analysis weighted for individual study size. Weighted means and standard deviations were calculated for postoperative glucose levels. Across the 12 studies, 46,685 patients were included, of which 23,892 received at least one dose of dexamethasone.

Results: Dexamethasone administration in diabetic patients resulted in significantly elevated mean glucose levels (mg/dL) on POD1 compared to patients in whom dexamethasone was withheld (170.1 ± 5.3 versus 158.1 ± 5.8, P = 0.0007). However, 95% confidence interval levels were below the 200 mg/dL threshold. Additionally, there were no significant differences on POD2 (P = 0.23) and POD3 (P = 0.16). The risk of infection was not significantly different between the intervention and control groups (risk ratio: 0.82, 95% CI [confidence interval]: 0.39 to 1.72, P = 0.61). Due to the heterogeneity of data, and only four studies reporting exact dosages as opposed to ranges, an ideal dosage of dexamethasone could not be found.

Conclusion: Administration of perioperative dexamethasone in diabetic patients appears to be safe. Further investigation is warranted regarding dosage and timing of administration to optimize beneficial effects of dexamethasone while preventing excessive hyperglycemia in diabetic patients.

Level of evidence: IV.

Keywords: dexamethasone; diabetes; pain management; total joint arthroplasty.

Publication types

Review