Department of Orthopaedics, Midland Regional Hospital Tullamore, Puttaghan, Tullamore, Ireland.
Department of Anaesthetics, Starship Children's Hospital, Auckland, New Zealand.
J Arthroplasty. 2021 Aug;36(8):3042-3053. doi: 10.1016/j.arth.2021.03.057. Epub 2021 Apr 24.
Perioperative corticosteroid administration is associated with reduced postoperative nausea, pain, and enhanced recovery after surgery. However, potential complications including wound and periprosthetic joint infections remain a concern for surgeons after total joint arthroplasty (TJA).
A systematic review of the search databases PubMed, Google Scholar, and EMBASE was made in January 2021 to identify comparative studies evaluating infection risk after perioperative corticosteroid administration in TJA. PRISMA guidelines were used for this review. Meta-analysis was used to assess infection risk in accordance with joint and corticosteroid dosing regimen used.
201 studies were returned after initial search strategy, with 29 included for review after application of inclusion and exclusion criteria. Studies were categorized as using low- or high-dose corticosteroid with single or repeat dosing regimens. Single low-dose corticosteroid administration was not associated with an increased risk of infection (P = .4; CI = 0.00-0.00). Single high-dose corticosteroid was not associated with an increased infection risk (P = .3; CI = 0.00-0.01) nor did repeat low-dose regimens result in increased risk of infection (P = .8; CI = -0.02-0.02). Studies assessing repeat high-dosing regimens reported no increased infection, with small numbers of participants included. No significant risk difference in infection risk was noted in hip (P = .59; CI = -0.03-0.02) or knee (P = .2; CI = 0.00-0.01) arthroplasty. Heterogeneity in patient profiles included in studies to date was noted.
Use of perioperative corticosteroid in TJA does not appear to be associated with increased risk of postoperative infection in patients with limited comorbidities. Further research is warranted to evaluate postoperative complications after TJA in these at-risk patient populations.
围手术期皮质类固醇的应用与术后恶心、疼痛减轻和手术恢复加速有关。然而，在全膝关节置换术（TJA）后，潜在的并发症，包括伤口和假体周围关节感染，仍然是外科医生关注的问题。
我们于 2021 年 1 月对 PubMed、Google Scholar 和 EMBASE 等搜索数据库进行了系统评价，以确定评估围手术期皮质类固醇给药后 TJA 感染风险的比较研究。本综述采用 PRISMA 指南。根据使用的关节和皮质类固醇剂量方案进行了荟萃分析，以评估感染风险。
初始搜索策略后返回了 201 项研究，经过纳入和排除标准的应用，有 29 项研究被纳入综述。这些研究分为使用低剂量或高剂量皮质类固醇，以及单次或重复剂量方案。单次低剂量皮质类固醇给药与感染风险增加无关（P =.4；CI = 0.00-0.00）。单次高剂量皮质类固醇给药与感染风险增加无关（P =.3；CI = 0.00-0.01），重复低剂量方案也不会增加感染风险（P =.8；CI = -0.02-0.02）。评估重复高剂量方案的研究报告没有增加感染，参与者数量较少。在髋关节（P =.59；CI = -0.03-0.02）或膝关节（P =.2；CI = 0.00-0.01）置换术方面，未观察到感染风险的显著差异。迄今为止，纳入研究的患者特征存在异质性。
在合并症有限的 TJA 患者中，围手术期皮质类固醇的使用似乎不会增加术后感染的风险。需要进一步研究来评估这些高危患者人群中 TJA 后的术后并发症。
