Efficacy of Vitamin C as Glucocorticoid Substitute for Reducing Pain and Inflammation After Total Hip Arthroplasty: A Randomized Controlled Trial.

Abstract

BACKGROUND Vitamin C shows strong anti-inflammatory and analgesic effects, so we explored whether it can replace glucocorticoids in reducing pain and inflammation after total hip arthroplasty (THA). METHODS In this prospective trial, a consecutive series of 107 patients (43.0% men, 56.8 ± 10.1 years of age, 100% Han Chinese) who underwent THA due to end-stage hip disease at our medical center between January 2023 and January 2024 were randomized to receive vitamin C, dexamethasone, or neither dexamethasone nor vitamin C after surgery. The 3 groups were compared in terms of the primary outcomes of pain reported on a visual analogue scale (VAS), perioperative morphine use, and blood indices of inflammation and fibrinolysis as well as in terms of secondary outcomes of efficacy and safety. RESULTS Compared with patients in the control group, those who received vitamin C or dexamethasone reported a significantly lower VAS pain score on postoperative day 1, had significantly lower perioperative morphine consumption, and demonstrated significantly lower blood levels of C-reactive protein on days 1 and 2. The 2 groups also showed a significantly lower rate of rescue analgesia on postoperative day 1 and significantly higher Harris hip scores of joint function at 2 and 12 weeks after surgery, as well as significantly smaller thigh circumference and a lower rate of swelling on the first 2 days after surgery. Either treatment was associated with a significantly lower rate of postoperative nausea and vomiting. Dexamethasone was associated with greater blood glucose levels after surgery. CONCLUSIONS Vitamin C may be an effective substitute for glucocorticoids for reducing morphine use and the risk of nausea or vomiting and for improving joint function after THA without side effects causing blood glucose fluctuations. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.