Effect of systemic steroids administration in the clinical outcome of total hip arthroplasty: a systematic review and meta-analysis of prospective randomized controlled trials

Introduction: Perioperative steroids administration in total joint arthroplasty gained popularity for pain relief, reduction of postoperative nausea and vomiting (PONV) and enhanced recovery. The purpose of this study is to systematically review and meta-analyze comparative results of prospective randomized trials focused on the effect of systemic steroid administration at different dosages in THA for hip osteoarthritis. The hypothesis is that perioperative systemic steroid administration has a positive impact on postoperative outcomes.

Material and methods: A systematic review of the literature has been performed, following the Cochrane Handbook of Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for study selection. A comprehensive search was performed across multiple databases (Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, Embase, Scopus, the Science Citation Index Expanded from Web of Science, ScienceDirect, CINAHL and LILACS) covering the period from 1990 to 2023. Placebo-controlled, prospective randomized trials that reported comparative outcomes of total hip arthroplasty (THA) with the use of systemic corticosteroids during the perioperative period were considered eligible for inclusion.

Results: A total of 8 prospective randomized trials involving 675 patients who underwent elective THA (369 in the study group and 306 in the control group) were finally included in this systematic review. Perioperative systemic steroid administration in THA provides a significant benefit in terms of length of stay (LOS), pain, opioid consumption, postoperative nausea and vomiting (PONV) and inflammatory response without improving post-operative complications. The high-dose steroid administration (≥ 20 mg of steroid equivalent) provided only a reduction of the inflammatory response of measured biomarkers at 24 and 48 h.

Conclusions: The use of steroids in total hip arthroplasty (THA) has positive effects in terms of reducing length of stay (LOS), post operative pain, opioid use, postoperative nausea and vomiting (PONV) and systemic inflammatory response.