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Wegener JT, Kraal T, Stevens MF, et al. Low-dose dexamethasone during arthroplasty: What do we know about the risks?. EFORT Open Rev. 2017;1(8):303-309doi: 10.1302/2058-5241.1.000039.
Wegener, J. T., Kraal, T., Stevens, M. F., Hollmann, M. W., Kerkhoffs, G. M. M. J., & Haverkamp, D. (2016). Low-dose dexamethasone during arthroplasty: What do we know about the risks?. EFORT open reviews, 1(8), 303-309. https://doi.org/10.1302/2058-5241.1.000039
Wegener, Jessica T, et al. "Low-dose dexamethasone during arthroplasty: What do we know about the risks?." EFORT open reviews vol. 1,8 (2016): 303-309. doi: https://doi.org/10.1302/2058-5241.1.000039
Wegener JT, Kraal T, Stevens MF, Hollmann MW, Kerkhoffs GMMJ, Haverkamp D. Low-dose dexamethasone during arthroplasty: What do we know about the risks?. EFORT Open Rev. 2017 Mar 13;1(8):303-309. doi: 10.1302/2058-5241.1.000039. eCollection 2016 Aug. PMID: 28461961; PMCID: PMC5367537.
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EFORT Open Rev. 2017 Mar 13;1(8):303-309. doi: 10.1302/2058-5241.1.000039. eCollection 2016 Aug.

Low-dose dexamethasone during arthroplasty: What do we know about the risks?.

EFORT open reviews

Jessica T Wegener, Tim Kraal, Markus F Stevens, Markus W Hollmann, Gino M M J Kerkhoffs, Daniël Haverkamp

Affiliations

  1. Department of Anesthesiology, Academic Medical Center (AMC), University of Amsterdam, The Netherlands.
  2. Department of Orthopedic Surgery, Academic Medical Center and the Orthopedic Research Center Amsterdam, The Netherlands.
  3. Department of Orthopedic Surgery, Slotervaart Ziekenhuis, Amsterdam, The Netherlands.

PMID: 28461961 PMCID: PMC5367537 DOI: 10.1302/2058-5241.1.000039

Abstract

Dexamethasone is commonly applied during arthroplasty to control post-operative nausea and vomiting (PONV). However, conflicting views of orthopaedic surgeons and anaesthesiologists regarding the use of dexamethasone raise questions about risks of impaired wound healing and surgical site infections (SSI).The aim of this systematic review is to determine the level of evidence for the safety of a peri-operative single low dose of dexamethasone in hip and knee arthroplasty.We systematically reviewed literature in PubMed, EMBASE and Cochrane databases and cited references in articles found in the initial search from 1980 to 2013 based on predefined inclusion criteria. The review was completed with a 'pro' and 'con' discussion.After identifying 11 studies out of 104, only eight studies met the inclusion criteria. In total, 1335 patients were studied without any incidence of SSI. Causes of SSI are multifactorial. Therefore, 27 205 patients would be required (power = 90%, alpha = 0.05) to provide substantiated conclusions on safety of a single low dose of dexamethasone.Positively, many studies demonstrated showed convincing effects of low-dose dexamethasone on prevention of PONV and dose-dependent effects on post-operative pain and quality of recovery. Dexamethasone induces hyperglycaemia, but none of the studies demonstrated a concomitant SSI.Conversely, animal studies showed that high dose dexamethasone inhibits wound healing.A team approach of anaesthesiologists and orthopaedic surgeons is mandatory in order to balance the risk-benefit ratio of peri-operatively applied steroids for individual arthroplasty patients.We did not find evidence that a single low dose of dexamethasone contributes to SSI or wound healing impairment from the current studies. Cite this article: Wegener JT, Kraal T, Stevens MF, Hollman MW, Kerkhoffs GMMJ, Haverkamp D. Low-dose dexamethasone during arthroplasty: what do we know about the risks?

Keywords: PONV; SSI; arthroplasty; hip; knee; post-operative nausea and vomiting; surgical site infections

Conflict of interest statement

Conflict of Interest: None declared.

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