Dexamethasone is Associated with Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty.

Introduction: The utilization of cemented femoral fixation during total hip arthroplasty (THA) has increased in recent years. Perioperative corticosteroids have been shown to attenuate the inflammatory cascade associated with cement-induced cardiopulmonary complications. Therefore the purpose of this study was to determine if dexamethasone (DEX) utilization was associated with decreased perioperative pulmonary complications associated with cemented THA.

Methods: Patients who underwent a cemented THA from January 1, 2015, to December 31, 2021, were identified using a nationwide medical database. There were two cohorts were identified: patients who received intravenous DEX [DEX(+)] and those who did not [DEX(-)] on the day of surgery. The 90-day risk of pulmonary complications was compared between the DEX(+) and DEX(-) cohorts. Multivariable analyses accounting for potentially confounding variables, including demographic, comorbidity, and venous thromboembolic chemoprophylactic agents, were performed. In total, 27,017 cemented THAs were identified, of which 14,743 (54.6%) received DEX and 12,274 (45.4%) did not.

Results: The DEX(+) cohort had fewer aggregate pulmonary complications (5.0 versus 8.3%, P < 0.001), was less likely to experience acute respiratory failure (3.6% versus 5.7%, P < 0.001), re-intubation (0.6% versus 1.1%, p<0.001), pneumonia (2.1% versus 4.2%, p<0.001) or pulmonary edema (0.6% versus 1.1, P < 0.001) compared to the DEX(-) cohort. After accounting for potential confounders, the DEX(+) cohort was at decreased risk of aggregate pulmonary complications (adjusted odds ratio [aOR]: 0.83, 95% confidence interval [CI]: 0.74 to 0.92, P = 0.001), pneumonia (aOR: 0.73, 95% CI: 0.63 to 0.85, P < 0.001) and pulmonary edema (aOR: 0.72, 95% CI: 0.54 to 0.96, P = 0.026) compared to the DEX(-) cohort.

Conclusion: Perioperative DEX administration was associated with a significantly decreased risk of aggregate pulmonary complications, including pneumonia and pulmonary edema, following cemented THA. Orthopaedic surgeons utilizing cement fixation in THA should consider the utilization of perioperative DEX.