Chronic Pain and Functional Outcome 3 years After Total Knee Arthroplasty and Perioperative Dexamethasone: A Follow-Up of the Randomized, Clinical DEX-2-TKA Trial

Asger K Mølgaard; Kasper S Gasbjerg; Søren T Skou; Ole Mathiesen; Daniel Hägi-Pedersen

doi:10.1016/j.arth.2023.05.060

Chronic Pain and Functional Outcome 3 years After Total Knee Arthroplasty and Perioperative Dexamethasone: A Follow-Up of the Randomized, Clinical DEX-2-TKA Trial

J Arthroplasty. 2023 Dec;38(12):2592-2598.e2. doi: 10.1016/j.arth.2023.05.060. Epub 2023 Jun 5.

Authors

Asger K Mølgaard¹, Kasper S Gasbjerg¹, Søren T Skou², Ole Mathiesen³, Daniel Hägi-Pedersen⁴

Affiliations

¹ Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark.
² The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
³ Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen N, Denmark.
⁴ Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen N, Denmark.

PMID: 37286048
DOI: 10.1016/j.arth.2023.05.060

Abstract

Background: Perioperative dexamethasone as an adjunct to multimodal analgesia, has an opioid-sparing and pain alleviating effect after total knee arthroplasty (TKA), however, the 3-year effects are unknown. We aimed to investigate the 3-year effect of 1 (DX1) or 2 (DX2) intravenous doses of 24 mg dexamethasone or placebo on pain, physical function, and health-related quality of life after TKA.

Methods: Patients who participated in the Dexamethasone Twice for Pain Treatment after TKA (DEX-2-TKA) were invited to physical tests and questionnaires (self-reported characteristics, Oxford Knee Score, EuroQol-5Dimensions-5Levels (EQ5D5L), and PainDetect). The tests were 40-meter Fast Paced Walk (40FPW) test, Timed Up and Go (TUG), 30 Second Chair Stand test (30CST), Stair Climb Test (SCT), bilateral knee Range of Motion, and knee extension torque. For each test the peak pain intensity was registered on a 0 to 100 mm Visual Analogue Scale. Primary outcome was average peak pain intensity during the 40FPW, TUG, 30CST and SCT. Secondary outcomes were the tests and questionnaires. Out of 252 eligible patients, 133 (52.8%) underwent the tests and 160 (63.5%) answered the questionnaires. Mean follow-up time was 33 months (range, 23 to 40).

Results: Median (interquartile range) peak pain intensity was 0 (0 to 65) for the DX2 group, 0 (0 to 51) for DX1 group and 0 (0 to 70) for the placebo group (P = .72). No differences in secondary outcomes were identified.

Conclusion: One or 2 intravenous doses of 24 mg dexamethasone did not impact chronic pain development or physical function 3 years after TKA.

Trial registration: ClinicalTrials.gov NCT05137080.

Keywords: chronic pain; dexamethasone; glucocorticoid; osteoarthrosis; total knee arthroplasty.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Knee* / adverse effects
Chronic Pain*
Dexamethasone / therapeutic use
Follow-Up Studies
Humans
Pain, Postoperative / drug therapy
Pain, Postoperative / etiology
Pain, Postoperative / prevention & control
Quality of Life

Substances

Dexamethasone

Associated data

ClinicalTrials.gov/NCT05137080