ReviewArthroplasty (London, England)2026
Comparative clinical efficacy and safety of perioperative systemic glucocorticoids in primary unilateral total hip arthroplasty: a GRADE-assessed meta-analysis of randomized controlled trials.
Review in Arthroplasty (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRecovery from primary unilateral total hip arthroplasty (THA) is frequently impeded by pain and postoperative nausea and vomiting (PONV), which hinder Enhanced Recovery After Surgery (ERAS) goals. Although perioperative glucocorticoids offer a multimodal strategy to address these challenges, evidence remains inconsistent, and prior syntheses have often combined THA with total knee arthroplasty, preventing definitive conclusions. Therefore, we conducted this GRADE-assessed meta-analysis to determine the specific efficacy and safety of systemic glucocorticoids in primary unilateral THA.
methodsWe conducted a comprehensive search of PubMed, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) published through October 17, 2025. Twelve RCTs met the inclusion criteria. Primary outcomes included pain (Visual Analog Scale, VAS), PONV incidence, opioid consumption, and glycemic control. Secondary outcomes included length of stay (LOS), C-reactive protein (CRP), interleukin-6 (IL-6), and complications. Risk of bias was assessed using the Cochrane RoB 2 tool. Data were pooled using a random-effects model, and results were expressed as mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs).
resultsA total of 1,128 patients were included in this meta-analysis. The pooled analysis revealed that systemic glucocorticoids were associated with a significant reduction in pain at rest (MD - 0.20 cm; 95% CI - 0.38 to - 0.01; p = 0.04; I
conclusionPerioperative systemic glucocorticoids appear to modestly reduce early pain, though this reduction did not reach the MCID threshold. They were also associated with reduced PONV, shorter hospital stays, and lower inflammatory markers, without increasing short-term wound complications or infections in predominantly non-diabetic patients. Glycemic levels were not meaningfully affected in this population. Evidence for opioid-sparing effects remains inconsistent, and these results should be considered hypothesis-generating rather than definitive. Critically, these findings should not be extrapolated to diabetic patients, and routine use in this high-risk population cannot be recommended without targeted prospective trials. Future RCTs are needed to determine optimal dosing-single intravenous dexamethasone 10-20 mg represents a reasonable candidate for investigation-and to confirm safety in high-risk populations before formal clinical guidance can be established.
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