# A Single Perioperative Dose of Dexamethasone Is Not Associated With an Increased Risk of Infection in Patients With Hip or Knee Osteoarthritis Considered for Elective Primary Total Hip or Total Knee Arthroplasty

## TL;DR

A single dose of dexamethasone before hip or knee surgery does not increase infection risk in patients with osteoarthritis.

## Contribution

First single-dose, single-hospital study with standardized infection diagnostics showing no increased infection risk from dexamethasone.

## Key findings

- 54 periprosthetic joint infections were observed, with 6 in the dexamethasone group and 48 in the non-dexamethasone group.
- Multivariate analysis showed no increased odds of infection with dexamethasone use (odds ratio 0.80, 95% CI 0.30-1.73).

## Abstract

Perioperative dexamethasone administration has been associated with reduced postoperative nausea, pain, and enhanced recovery after total hip (THA) and knee arthroplasty (TKA). However, there is ongoing concern about the influence of glucocorticoids on periprosthetic joint infection (PJI) due to the high heterogeneity of available studies. The present study aimed to evaluate the effect of perioperative dexamethasone use on early and delayed PJI after THA and TKA in patients with primary osteoarthritis.

A consecutive cohort of patients from a single teaching hospital were analyzed. For each procedure, the intravenous application of 0.15 mg/kg dexamethasone in a single dose perioperatively was recorded. Additionally, patient characteristics, joint affected and the revision surgery due to infection after primary surgery were collected from the hospital registry and medical records. All patients with revision surgery for PJI were subjected to the standard protocol of perioperative diagnostics.

Between 2017 and 2023, a total of 8905 procedures were included, 1318 with perioperative dexamethasone application and 7587 without. The patients who received perioperative dexamethasone (dexa group) were similar in age (effect size (ES) = 0.03), sex (ES = 0.002), body mass index (ES = 0.06) and American Society of Anaesthesiologists score (ES = 0.06) compared to patients who did not (non-dexa group). In total, 54 PJIs were observed, 6 of them were in dexamethasone and 48 in the non-dexamethasone group. Multivariate logistic regression showed that the use of dexamethasone was not associated with higher odds for PJI within the first 2 postoperative years (odds ratio 0.80 95% confidence interval 0.30-1.73; P = .603).

Our study is the first single-dose, single-hospital study with standardized PJI diagnostic procedures at revision surgery, which shows that perioperative intravenous dexamethasone has no association with an increased risk of early or delayed PJI in THA and TKA in patients with primary osteoarthritis. The present data provide evidence in support of the perioperative administration of a single dose of dexamethasone.