JOA - 2026-04-24 - Journal Article
Methylprednisolone Taper after Total Knee Arthroplasty: A Prospective Single-Blinded Randomized Trial.
Premkumar A, Arellano E, Heo KY, Manz WJ, Hrudka B, Nour G, Fuqua A, Rieger E, Ayeni AM, Brito M, Syed O, Sheth N, Erens GA, Roberson J, Wilson JM
Topics
Key Takeaway
A six-day oral methylprednisolone taper after primary TKA significantly reduced POD1 nausea (p<0.05) but produced only a non-significant trend toward reduced cumulative opioid consumption (95.47 vs 116.91 OME) without increasing complications.
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Summary
This single-blinded RCT evaluated whether a six-day oral methylprednisolone taper (Medrol Dosepak) added to a standardized multimodal analgesic regimen reduced pain and opioid consumption in the first week after primary TKA for OA. The MPT group demonstrated a statistically significant reduction in POD1 nausea VAS scores and a non-significant reduction in cumulative OME (95.47 vs 116.91). No difference in pain scores, ROM at 3 months, or complication rates was observed between groups.
Key Limitation
The trial was underpowered to detect a statistically significant difference in opioid consumption, as the observed 18% reduction in cumulative OME (95.47 vs 116.91) may represent a clinically meaningful effect that a larger sample would confirm.
Original Abstract
BACKGROUND
The use of short-term postoperative corticosteroid regimens has been reported to improve pain control and decrease opioid consumption following total knee arthroplasty (TKA). The purpose of this study was to evaluate the effect of a methylprednisolone taper (MPT) on reducing patients' subjective pain levels and opioid consumption in the early postoperative period following primary TKA.
METHODS
This was a prospective single-blinded randomized controlled trial of patients undergoing primary TKA for osteoarthritis. Patients were randomized to receive a standardized multimodal pain control regimen alone or the same regimen with a six-day oral MPT (i.e., Medrol Dosepak). Patient pain and nausea visual analog scale (VAS) scores, as well as opioid consumption data, were collected for seven days, while knee range of motion (ROM) was collected preoperatively and at the three-month follow-up visit. An a priori power analysis was conducted, and 69 patients were enrolled from October 2023 to March 2025, with 34 randomized into the control group and 35 into the MPT group.
RESULTS
Patients in the MPT group reported significantly decreased nausea levels on postoperative day one (P < 0.05). Daily and cumulative oral morphine equivalents (OMEs) were decreased in the MPT group over the first postoperative week, with a mean cumulative OME of 95.47 versus 116.91, though this did not reach statistical significance. The majority of patients stopped opioids by day seven in both groups. Pain scores were lower, but not significantly so, in the MPT group. There were no increased complications seen in the MPT group. Range of motion changes were equivalent between groups.
CONCLUSIONS
This randomized controlled trial demonstrated a significant reduction in nausea levels on postoperative day one and a non-significant trend toward reduced pain and opioid use with a six-day MPT following primary TKA for osteoarthritis in the context of a multimodal postoperative regimen. Importantly, we observed no increased complications with the use of a MPT.