Dexamethasone in Total Knee Arthroplasty

NCT ID: NCT05018091

Last Updated: 2025-08-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

404 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-28

Study Completion Date

2025-05-30

Brief Summary

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The purpose of this study is to determine the most efficacious and safest dexamethasone dose given intraoperatively during total knee arthroplasty that reduces postoperative opioid consumption and pain, improves postoperative nausea and vomiting, and minimizes postoperative complications.

Detailed Description

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Study design: Prospective randomized controlled trial

Scientific Background: In contemporary total joint arthroplasty (TJA), multimodal anesthesia and analgesia is used to improve postoperative pain, reduce opioid consumption, and minimize complications after surgery such as postoperative nausea and vomiting.1-3 Multiple medications with varying mechanisms of action are used at different time points throughout the perioperative period to modulate different pain receptors. Corticosteroids are a medication commonly utilized intraoperatively as part of contemporary multimodal protocols.

Corticosteroids are frequently used in TJA due to their potent anti-inflammatory and anti-emetic properties. Several studies have demonstrated that corticosteroids reduce postoperative nausea and vomiting as well as postoperative pain and opioid consumption.4-6 However, the optimal medication, dose, and number of doses of corticosteroid that should be administered in the perioperative period remain unknown. In addition, it remains unclear if corticosteroids can be safely used in patients with diabetes mellitus or if corticosteroids increase the risk of postoperative complications such as periprosthetic joint infection. Thus, the purpose of our study is to determine the most efficacious and safest dose of corticosteroids that should be administered intraoperatively during TJA.

Conditions

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Total Knee Arthroplasty

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Group 1

4mg intravenous dexamethasone, administered shortly after induction of anesthesia

Group Type ACTIVE_COMPARATOR

Dexamethasone 4mg

Intervention Type DRUG

4mg intravenous dexamethasone, administered shortly after induction of anesthesia

Group 2

8mg intravenous dexamethasone, administered shortly after induction of anesthesia

Group Type ACTIVE_COMPARATOR

Dexamethasone 8 Mg/mL Injectable Suspension

Intervention Type DRUG

8mg intravenous dexamethasone, administered shortly after induction of anesthesia

Group 3

16mg intravenous dexamethasone, administered shortly after induction of anesthesia

Group Type ACTIVE_COMPARATOR

Dexamethasone 16mg

Intervention Type DRUG

16mg intravenous dexamethasone, administered shortly after induction of anesthesia

Interventions

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Dexamethasone 4mg

4mg intravenous dexamethasone, administered shortly after induction of anesthesia

Intervention Type DRUG

Dexamethasone 8 Mg/mL Injectable Suspension

8mg intravenous dexamethasone, administered shortly after induction of anesthesia

Intervention Type DRUG

Dexamethasone 16mg

16mg intravenous dexamethasone, administered shortly after induction of anesthesia

Intervention Type DRUG

Other Intervention Names

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Group 1 Group 2 Group 3

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years
* Primary total knee arthroplasty
* Patients staying at least one night in the hospital after surgery

Exclusion Criteria

* Same day discharge Age \< 18 years Revision or partial total knee arthroplasty Corticosteroid use within 3 months prior to surgery Inflammatory arthritis Current systemic fungal infection Renal or liver failure Prior adverse reaction to corticosteroid Primary TKA requiring hardware removal
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Rush University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Craig J Della Valle, MD

Professor of Orthopedic Surgery, Chief Division of Adult Reconstruction

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Stanford University

Redwood City, California, United States

Site Status

University of California, San Francisco

San Francisco, California, United States

Site Status

Rush University medical Center

Chicago, Illinois, United States

Site Status

Mass General Brigham

Somerville, Massachusetts, United States

Site Status

Mayo Clinic Institutional Review

Rochester, Minnesota, United States

Site Status

Washington University

St Louis, Missouri, United States

Site Status

NYU Langone Health

New York, New York, United States

Site Status

Columbia University Irving Medical Center

New York, New York, United States

Site Status

University of Pennsylvania Perelman School of Medicine

Philadelphia, Pennsylvania, United States

Site Status

Jefferson Philadelphia University and Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Moucha CS, Weiser MC, Levin EJ. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty. J Am Acad Orthop Surg. 2016 Feb;24(2):60-73. doi: 10.5435/JAAOS-D-14-00259.

Reference Type BACKGROUND
PMID: 26803543 (View on PubMed)

Hannon CP, Keating TC, Lange JK, Ricciardi BF, Waddell BS, Della Valle CJ. Anesthesia and Analgesia Practices in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership. J Arthroplasty. 2019 Dec;34(12):2872-2877.e2. doi: 10.1016/j.arth.2019.06.055. Epub 2019 Jul 8.

Reference Type BACKGROUND
PMID: 31371038 (View on PubMed)

Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011 Jun 1;93(11):1075-84. doi: 10.2106/JBJS.J.01095.

Reference Type BACKGROUND
PMID: 21655901 (View on PubMed)

Lex JR, Edwards TC, Packer TW, Jones GG, Ravi B. Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty. 2021 Mar;36(3):1168-1186. doi: 10.1016/j.arth.2020.10.010. Epub 2020 Oct 16.

Reference Type BACKGROUND
PMID: 33190999 (View on PubMed)

Lunn TH, Kehlet H. Perioperative glucocorticoids in hip and knee surgery - benefit vs. harm? A review of randomized clinical trials. Acta Anaesthesiol Scand. 2013 Aug;57(7):823-34. doi: 10.1111/aas.12115. Epub 2013 Apr 15.

Reference Type BACKGROUND
PMID: 23581549 (View on PubMed)

Chen P, Li X, Sang L, Huang J. Perioperative intravenous glucocorticoids can decrease postoperative nausea and vomiting and pain in total joint arthroplasty: A meta-analysis and trial sequence analysis. Medicine (Baltimore). 2017 Mar;96(13):e6382. doi: 10.1097/MD.0000000000006382.

Reference Type BACKGROUND
PMID: 28353565 (View on PubMed)

Other Identifiers

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21081102

Identifier Type: -

Identifier Source: org_study_id

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