Systemic Low Dose Corticosteroid Improves Early Postoperative Knee Function and Pain Intensity in Patients Undergoing Unilateral Total Knee Arthroplasty: A Blinded Controlled Randomized Clinical Trial.

Background: This randomized controlled trial evaluates low-dose oral corticosteroids for improving pain and function after total knee arthroplasty (TKA), leveraging their potent anti-inflammatory effects. Methods: A total of 102 patients who underwent primary unilateral TKA were randomized to receive either 400 mg of celecoxib plus 10 mg of oral prednisolone daily or 400 mg of celecoxib alone. Oral medications started after discharge (24-48 hours after surgery) and continuing for 2 weeks. Follow-up visits were conducted at 1, 2, 4, 12, and 24 weeks postsurgery. The Visual Analog Scale, range of motion (ROM), Knee Society Score, Oxford Knee Score, and sleep quality were evaluated. Results: Demographic data were similar, except for age, with celecoxib alone group being older (p = 0.005). The celecoxib + prednisolone group experienced significantly lower Visual Analog Scale pain scores at 1 week (mean difference [MD]: -0.81; 95% confidence interval [CI]: -1.59 to -0.03) and 2 weeks (MD: -0.99; 95% CI: -1.87 to -0.09) postoperatively. Age-adjusted results confirmed the reduction in pain with a slight difference, although it was not statistically significant. Knee function scores showed statistically significant improvement in the celecoxib + prednisolone group at 2 weeks (MD: 12.96; 95% CI: 0.21-26.13). Improvement in knee function scores was reduced by about half in age-adjusted analysis and was not statistically significant (MD: 6.25, p = 0.35). ROM demonstrated significant difference at 4 weeks (MD: 6.66; 95% CI: 0.44-12.86). Sleep quality showed significant improvement in the celecoxib + prednisolone group at 2 weeks (MD: 0.84; 95% CI: 0.05-1.64). Improvement was clinically confirmed by controlling for the effect of age with borderline significance. Uncertainty was observed due to wide CIs in some results. Conclusion: Oral low-dose prednisolone administered early after TKA resulted in significant reductions in pain and improvements in sleep quality, ROM, and Knee Society Score during the early postoperative period. However, these improvements did not consistently reach the minimal clinically important difference. Adjusted analyses accounting for age suggested modest benefits, but wide CIs and small effect sizes warrant cautious interpretation. To optimize dosing regimens and assess the long-term effects of oral corticosteroids in TKA recovery protocols, large-scale randomized controlled trials are necessary. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.