Alessio-Mazzola Mattia, D'Andrea Giulia, Abu-Mukh Assala, Mosca Salvatore, Placella Giacomo, Salini Vincenzo
Unità Clinica di Ortopedia e Traumatologia, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Università Vita-Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy.
Arch Orthop Trauma Surg. 2024 Dec 21;145(1):78. doi: 10.1007/s00402-024-05626-6.
Perioperative steroids administration in total joint arthroplasty gained popularity for pain relief, reduction of postoperative nausea and vomiting (PONV) and enhanced recovery. The purpose of this study is to systematically review and meta-analyze comparative results of prospective randomized trials focused on the effect of systemic steroid administration at different dosages in THA for hip osteoarthritis. The hypothesis is that perioperative systemic steroid administration has a positive impact on postoperative outcomes.
A systematic review of the literature has been performed, following the Cochrane Handbook of Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for study selection. A comprehensive search was performed across multiple databases (Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, Embase, Scopus, the Science Citation Index Expanded from Web of Science, ScienceDirect, CINAHL and LILACS) covering the period from 1990 to 2023. Placebo-controlled, prospective randomized trials that reported comparative outcomes of total hip arthroplasty (THA) with the use of systemic corticosteroids during the perioperative period were considered eligible for inclusion.
A total of 8 prospective randomized trials involving 675 patients who underwent elective THA (369 in the study group and 306 in the control group) were finally included in this systematic review. Perioperative systemic steroid administration in THA provides a significant benefit in terms of length of stay (LOS), pain, opioid consumption, postoperative nausea and vomiting (PONV) and inflammatory response without improving post-operative complications. The high-dose steroid administration (≥ 20 mg of steroid equivalent) provided only a reduction of the inflammatory response of measured biomarkers at 24 and 48 h.
The use of steroids in total hip arthroplasty (THA) has positive effects in terms of reducing length of stay (LOS), post operative pain, opioid use, postoperative nausea and vomiting (PONV) and systemic inflammatory response.
全关节置换术中围手术期使用类固醇药物因能缓解疼痛、减少术后恶心呕吐（PONV）并促进康复而受到青睐。本研究的目的是系统回顾和荟萃分析前瞻性随机试验的比较结果，这些试验聚焦于不同剂量全身类固醇给药对髋关节骨关节炎全髋关节置换术（THA）的影响。假设是围手术期全身类固醇给药对术后结果有积极影响。
按照Cochrane干预措施系统评价手册以及系统评价和荟萃分析的首选报告项目（PRISMA）进行文献系统回顾以选择研究。在多个数据库（Cochrane对照试验中央注册库、MEDLINE/PubMed、Embase、Scopus、科学网扩展版科学引文索引、ScienceDirect、CINAHL和LILACS）中进行了全面检索，涵盖1990年至2023年期间。纳入标准为报告围手术期使用全身皮质类固醇进行全髋关节置换术（THA）比较结果的安慰剂对照前瞻性随机试验。
本系统评价最终纳入了8项前瞻性随机试验，共675例接受择期THA的患者（研究组369例，对照组306例）。THA围手术期全身类固醇给药在住院时间（LOS）、疼痛、阿片类药物消耗、术后恶心呕吐（PONV）和炎症反应方面有显著益处，但并未改善术后并发症。高剂量类固醇给药（≥20毫克类固醇等效物）仅在24小时和48小时时降低了测量生物标志物的炎症反应。
在全髋关节置换术（THA）中使用类固醇在缩短住院时间（LOS）、术后疼痛、阿片类药物使用、术后恶心呕吐（PONV）和全身炎症反应方面有积极作用。
