The Prognostic Role of Perioperative Dexamethasone in Aseptic Revision Hip Arthroplasty-A Retrospective Cohort Study.

Abstract

Objective: Aseptic hip revision arthroplasty often results in significant postoperative pain, inflammation, nausea, and vomiting. While perioperative dexamethasone has demonstrated benefits in primary hip arthroplasty, its efficacy and safety in revision procedures remain unclear. This study aims to evaluate the effects of perioperative dexamethasone on postoperative pain, inflammation, postoperative nausea and vomiting (PONV), and safety in aseptic hip revision.

Methods: A retrospective cohort study was conducted on 414 patients undergoing aseptic hip revision arthroplasty between 2008 and 2023. Patients were categorized into two groups: those receiving dexamethasone perioperatively (n = 218) and a control group (n = 196). Outcomes included Visual Analog Scale (VAS) pain scores, inflammation markers including C-reactive protein (CRP) and interleukin-6 (IL-6), PONV incidence, analgesic and antiemetic usage, length of stay (LOS), and postoperative complications. Independent samples t-test or Mann-Whitney U test is applied to continuous variables based on normality, while chi-square test or Fisher's exact test is used for categorical variables according to sample size.

Results: The dexamethasone group (average dose: 12.67 mg) exhibited significantly lower VAS scores (p < 0.001) and reduced morphine use on postoperative days (PODs) 1-3. CRP (POD2: 40.60 mg/L vs. 111.66 mg/L) and IL-6 levels (POD1: 31.85 pg/mL vs. 138.28 pg/mL) were significantly lower in the dexamethasone group (both p < 0.001). PONV incidence (28.4% vs. 40.81%) and antiemetic usage were reduced in the dexamethasone group. No significant differences were observed in LOS or postoperative complications between the two groups.

Conclusion: Perioperative low-dose dexamethasone effectively mitigates pain, inflammation, and PONV in aseptic hip revision arthroplasty without increasing the risk of complications.