Steroids in Total Knee Arthroplasty
Condition: Postoperative Pain; Inflammation; Osteoarthritis
MeSH terms: Osteoarthritis; Inflammation; Pain, Postoperative
Intervention: Dexamethasone 10 mg; Dexamethasone 20 mg; Standard multimodal pain management regimen; Placebo
Intervention description: Two doses of dexamethasone 10 mg will be given intravenously. The first dose will be given preoperatively within 3 hours of surgery and the second dose will be administered 8 hours after the first dose in the inpatient setting.; Two doses of dexamethasone 20 mg will be given intravenously. The first dose will be given preoperatively within 3 hours of surgery and the second dose will be administered 8 hours after the first dose in the inpatient setting.; The standard multimodal postoperative pain management regimen typically used for total knee arthroplasty consists of the following:
Preoperative:
Decadron: 10 or 20mg IV x 1 2 doses, 8 hours apart (if randomized to study group)
Intraoperative:
Ropivacaine: Given intraoperatively. Capsule, subcutaneous tissue/skin. Administered in standard fashion. (300mg)
Toradol: 30mg q 6hr for 6 total doses. 1st dose given intraoperatively at incision. The dose is 15 mg for older patients or if creatinine clearance (CrCl) is low.
Postoperative
Tylenol: 1000mg po q 8hr (scheduled)
Oxycodone: 5mg or 10mg q 3-4hr prn pain, If intolerant to Oxycodone: second agent line is Hydrocodone or Oral Dilaudid
IV Morphine (or Dilaudid): 1 or 2 mg q 2hr prn breakthrough pain
Morphine patient-controlled analgesia (PCA): only for failure of the above
Morphine Sulfate (MS) Contin: Use as backup prn pain; Participants in the placebo arm will receive two doses of saline intravenously. The first dose will be given preoperatively within 3 hours of surgery and the second dose will be administered 8 hours after the first dose in the inpatient setting.
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; BB 1101
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 1.0
Sex: All
Minimum age: 18 Years
Maximum age: 100 Years
Healthy volunteers: No
Keywords: Osteoarthritis; Postoperative pain; Total knee arthroplasty; Orthopaedics; Inflammation

Summary:

      The purpose of this study is to evaluate if the use of two small doses of intravenous (IV)
      steroids around the time of knee replacement surgery decrease a patient's pain or use of pain
      medication. The investigators will also determine if the subjects receiving the steroid will
      have better pain control and better postoperative outcomes after their surgery.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients undergoing primary total joint arthroplasty of the knee

          -  Adult patients ages 18-100 years

          -  Patients must have smart phone and/or device for app usage

        Exclusion Criteria:

          -  Current chronic steroid use

          -  Patients undergoing revision knee surgery

          -  Patients ambulating preoperatively with assistive devices

          -  Patients with avascular necrosis of the operative knee

          -  Patients with a history of an adverse reaction to glucocorticoid steroids

          -  Patients unable to provide informed consent

          -  Patients with inflammatory arthritis

          -  Prisoners

          -  Current smokers

          -  Patients <18 years of age

          -  Any patient with a complicated postoperative course that requires transfer to the
             Intensive Care Unit (ICU) or to another facility for further management will be
             removed from the study.

          -  Any contraindication that would prevent the patient from being treated with the
             standard multimodal postoperative pain management regimen History of infection of
             surgical knee.

          -  Patients with diabetes.

          -  Patients that have an intolerance to Toradol.

          -  Patients that do not have smart phone and/or device for app usage