research summary

Is Dexamethasone Administration During Total Hip and Knee Arthroplasty Safe in Patients with Diabetes?

Key Highlights

  • Among 261,474 patients with diabetes undergoing total hip or knee arthroplasty, nearly half received dexamethasone.
  • Dexamethasone was associated with decreased odds of periprosthetic joint infection and sepsis.
  • Patients given dexamethasone had a shorter mean hospital stay compared with those not receiving it.
  • Odds of postoperative hyperglycemia were higher in patients who received dexamethasone.

Perioperative dexamethasone administration was not associated with increased infectious complications in patients with diabetes undergoing total joint arthroplasty (TJA). In fact, the large database analysis demonstrated that dexamethasone use correlated with decreased odds of periprosthetic joint infection and sepsis, while also shortening hospital stay.

Dexamethasone is widely used during hip and knee arthroplasty to reduce postoperative pain and mitigate nausea and vomiting. However, evidence regarding its safety profile in patients with diabetes has been limited. Given the elevated risk of infection and postoperative complications in this population, determining whether dexamethasone exacerbates or mitigates those risks was essential for clinical decision-making.

To address this question, investigators used the Premier Healthcare Database to identify patients with diabetes undergoing elective primary TJA between 2015 and 2020. Patients who received intravenous dexamethasone on the day of surgery were compared with those who did not. Demographic factors, hospital characteristics, and comorbidity burden were evaluated, with standardized differences confirming similarity between groups. Multivariate logistic regression models were applied to assess 90-day risk of both infectious and noninfectious postoperative complications.

The final analysis included 261,474 patients with diabetes, of whom 122,631 (46.9%) received dexamethasone. Baseline demographic and clinical characteristics were similar between groups, with absolute standardized differences ranging from 0.00% to 2.33%. Compared with those who did not receive dexamethasone, patients in the dexamethasone cohort had significantly decreased odds of periprosthetic joint infection (adjusted odds ratio [aOR], 0.82; 95% CI, 0.75–0.90; P < .001) and sepsis (aOR, 0.80; 95% CI, 0.72–0.89; P < .001). They also experienced a shorter hospital stay (1.87 ± 1.60 days vs 2.27 ± 1.88 days; P < .001). However, dexamethasone use was associated with increased odds of postoperative hyperglycemia (aOR, 1.14; 95% CI, 1.10–1.18; P < .001).

“Use of perioperative dexamethasone was not associated with the increased risk of infectious complications among patients with diabetes undergoing TJA, supporting its safety in this high-risk population,” the authors concluded.

Reference
Kebaish KJ, Wang JC, Piple AS, et al. Is dexamethasone administration during total hip and knee arthroplasty safe in patients with diabetes? J Am Acad Orthop Surg. 2025;33(5):242-252. doi:10.5435/JAAOS-D-23-00513. Epub 2024 Oct 18.