Effects of Single or Repeated Doses of Dexamethasone on Postoperative Glycemia in Patients Who Have Diabetes Mellitus After Primary Total Joint Arthroplasty: A Randomized Controlled Trial

Haiwei Tang; Ping Mou; Xiaoyang Liu; Yahao Lai; Enze Zhao; Hong Xu; Tingxian Ling; Anjing Chen; Weinan Zeng; Kai Zhou; Zongke Zhou

doi:10.1016/j.arth.2025.06.049

Effects of Single or Repeated Doses of Dexamethasone on Postoperative Glycemia in Patients Who Have Diabetes Mellitus After Primary Total Joint Arthroplasty: A Randomized Controlled Trial

J Arthroplasty. 2025 Jun 18:S0883-5403(25)00754-5. doi: 10.1016/j.arth.2025.06.049. Online ahead of print.

Authors

Haiwei Tang¹, Ping Mou², Xiaoyang Liu¹, Yahao Lai¹, Enze Zhao¹, Hong Xu¹, Tingxian Ling¹, Anjing Chen¹, Weinan Zeng¹, Kai Zhou³, Zongke Zhou³

Affiliations

¹ Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
² Department of Rehabilitation Medicine, West China Hospital, Sichuan University; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
³ Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China. Electronic address: zhoukai_scu@scu.edu.cn.

PMID: 40541852
DOI: 10.1016/j.arth.2025.06.049

Abstract

Background: Perioperative dexamethasone (DEX) administration in total joint arthroplasty (TJA) has shown better clinical outcomes, but may induce blood glucose (BG) dysregulation and ultimately increase the risk of periprosthetic joint infection (PJI), raising concerns about its safety in diabetic patients. This study aimed to evaluate the effects of single or repeated DEX doses on perioperative BG levels in diabetic patients undergoing TJA.

Methods: A total of 135 patients who had diabetes were randomized into three groups: perioperative intravenous injection of normal saline (Group A, the placebo group), perioperative intravenous injection of 10 mg DEX (Group B), and perioperative intravenous injection of 10 plus 10 mg DEX (Group C). Primary outcomes included postoperative fasting BG (FBG) and postprandial blood glucose (PBG) levels. Secondary outcomes comprised BG variability and inflammatory markers. The incidence of complications was recorded. We also explored the risk factors for FBG levels ≥ 200 mg/dL or PBG levels ≥ 260 mg/dL RESULTS: Compared to Group A, the FBG levels were higher in Group B on postoperative days (PODs) zero and one and in Group C on PODs zero, one, and two, with no differences in PBG. Elevated preoperative glycosylated hemoglobin A1c (HbA1c) levels (the threshold was 7.3 and 7.0%, respectively), but not DEX administration, increased the risk of FBG levels ≥ 200 mg/dL or PBG levels ≥ 260 mg/dL, respectively. The FBG variability increased slightly in groups B and C but remained below clinically relevant thresholds. No differences were found in postoperative complications among the three groups.

Conclusions: Perioperative intravenous administration of 10 mg or 10 plus 10 mg DEX in diabetic patients undergoing TJA has a transient effect on postoperative FBG levels and slightly increases glycemic variability. However, it is not a risk factor that leads to an elevation in BG levels to a critical threshold and theoretically does not increase the risk of PJI. Greater emphasis should be placed on HbA1c instead of DEX.

Keywords: blood glucose; dexamethasone; diabetes mellitus; periprosthetic joint infection; total joint arthroplasty.