Perioperative Dexamethasone Administration in Joint Arthroplasty

Perioperative administration of dexamethasone has become a cornerstone of enhanced recovery protocols in total hip and knee arthroplasty. As a potent synthetic glucocorticoid, dexamethasone attenuates the surgical stress response by suppressing pro-inflammatory cytokines, reducing postoperative nausea and vomiting, and diminishing acute pain intensity. Clinical strategies vary from single high-dose injections to repeated low-dose regimens, with evidence showing reductions in opioid consumption, inflammatory biomarkers (such as C-reactive protein and interleukin-6), and length of hospital stay. Concerns remain regarding transient hyperglycaemia and potential effects on wound healing or implant integration; however, accumulating data support a favourable safety profile when dosing is optimised. The global rise in joint replacement procedures underscores the practical significance of perioperative dexamethasone in improving functional outcomes and patient satisfaction worldwide.

Research from Nature Portfolio

A high-dimensional profiling study employing mass cytometry examined immune cell signalling trajectories in patients receiving perioperative glucocorticoids. This randomised trial demonstrated that glucocorticoid treatment selectively inhibits adaptive immune pathways—most notably T and B cell signalling—while preserving innate responses mediated by STAT3 and CREB phosphorylation. These findings clarify the mechanistic basis for dexamethasone’s analgesic and anti-emetic efficacy and underpin its safe use in surgical recovery by showing that critical innate processes associated with tissue repair remain intact.

Perioperative Dexamethasone Administration in Joint Arthroplasty publication trend

The graph below shows the total number of articles in perioperative dexamethasone administration in joint arthroplasty across all publications each year (not limited to Nature Index journals).

Technical terms

Perioperative: Relating to the period immediately before, during and after a surgical procedure.

Dexamethasone: A synthetic glucocorticoid used to suppress inflammation and modulate immune responses.

Arthroplasty: Surgical reconstruction or replacement of a joint, most commonly the hip or knee.

Multimodal Analgesia: The combined use of different classes of analgesics and techniques to achieve superior pain control.

Osseointegration: The process by which bone tissue grows to form a direct interface with an implanted device.

C-reactive protein (CRP): A liver-derived protein whose concentration rises in the blood in response to systemic inflammation.

Interleukin-6 (IL-6): A cytokine that plays a key role in acute-phase inflammatory responses.

References

1. Preferential inhibition of adaptive immune system dynamics by glucocorticoids in patients after acute surgical trauma. Nature Communications (2020).
2. Impact of Perioperative Dexamethasone Administration on Infection and Implant Osseointegration in a Preclinical Model of Orthopedic Device-Related Infection. Microorganisms (2024).
3. High-dose steroids in high pain responders undergoing total knee arthroplasty: a randomised double-blind trial. British Journal of Anaesthesia (2021).
4. Perioperative multiple low-dose Dexamethasones improves postoperative clinical outcomes after Total knee arthroplasty. BMC Musculoskeletal Disorders (2018).