Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement

Background: Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated. Methods: From October 2013, the departments reporting to the prospective Lundbeck Foundation Database for Fast-track Hip and Knee Replacement introduced preoperative methylprednisolone (MP) 125mg as part of a multimodal analgesic protocol in TKA. We analysed the risk of length of hospital stay (LOS) >4 days, 30 and 90 day readmissions in patients with MP vs patients having TKA before the use of MP and adjusted for comorbidity and place of surgery. An unadjusted comparison was specifically done to evaluate deep prosthetic infections. Results: Of a total of 3927 TKA procedures, 1442 received MP. Median LOS was 2 days in both groups, but the fraction with LOS >4 days was 6.0% vs 11.5% (P<0.001) in patients with MP vs those without, and with a reduced risk of LOS >4 days in adjusted analysis [ odds ratio (OR) 0.51; confidence interval (CI) 0.39-0.68; P<0.001]. Readmission rates were 5.6% (CI 4.5-6.9) vs 4.4% (P = 0.095) and 7.8% vs 7.3% (P = 0.53) at 30 and 90 days with and without MP, respectively. Adjusted analysis did not identify MP to be associated with 30 day (OR 1.18; CI 0.89-1.56; P = 0.25) or 90 day (OR 1.12; CI 0.861.46; P = 0.39) readmissions. The incidence of deep infections requiring surgical intervention was 0.8% vs 0.7% with MP vs without, respectively (P = 0.78). Conclusions: In this detailed prospective cohort study, preoperative high-dose glucocorticoid administration was not associated with LOS >4 days, readmissions or infectious complications in TKA patients without contraindications.