Abstract
Aim
Dexamethasone is often used as part of multimodal analgesia to prevent postoperative nausea and vomiting (PONV) and also to reduce postoperative pain. Because glucocorticoids have immunosuppressive and glucose-rising effects, the aim of current study was to examine if dexamethasone may be used safely in arthroplasty surgery.
Methods
All consecutive total primary and revision hip and knee arthroplasties performed in the Hospital District of Helsinki and Uusimaa, Peijas Hospital were analyzed (n=18 872). Emergency operations, for example total hip arthroplasties for femur fractures, were also included. Prospective surveillance for postoperative infections was performed. All infections meeting the Musculoskeletal Infection Society definition for prosthetic joint infection (PJI) were included.
Results
A total of 189 (1.0%) PJIs occurred: 0.8% after all primary arthroplasties and 1.9% after revision arthroplasties. The PJI rate after the emergency operations was 2.3 % (19/796). The PJI rate in the dexamethasone group was 1.0% (30/2 922) and in the non-dexamethasone group 1.0% (159/15 950), with no significant difference in the PJI incidence (P=0.849). The median time from the index operation to the infection was 16.0 (Q1–Q3 13.0–23.0) days. Total of 35 causative bacteria were cultured from the 30 PJI in dexamethasone group and 169 bacteria from the 159 PJI in non-dexamethasone group with no significant difference: Staphylococcus aureus (40.0% and 45.0%, respectively, P=1.000), Staphylococcus epidermidis (14.3% and 10.7%, P=0.375), other coagulase-negative staphylococci (11.4% and 11.8%, P=0.200), Streptococcus agalactiae (11.4% and 11.8%, P=0.695), Streptococcus betahemolyticus G (8.6% and 2.4%, P=0.081), other streptococci (0.0% and 4.1%, P=0.599), Enterococcus faecalis (2.9% and 5.3%, P=1.000), Enterobacter cloacae (2.9% and 3.6%, P=1.000), Pseudomonas aeruginosa (2.9% and 1.8%, P=0.502), and other bacteria (14.3% and 8.8%, P=0.544). Only one methicillin-resistant Staphylococcus aureus (MRSA) was detected in dexamethasone group. The proportion of polymicrobial PJIs was similar in both groups: 13.3% and 8.8%, respectively (p=0.495).
Conclusions
In our study material, the use of 5–10mg dose of dexamethasone did not increase the incidence of postoperative PJI. The single 5–10 dose of dexamethasone may be safely used to prevent PONV and as part of multimodal analgesia on patients undergoing arthroplasty operation.
