JOA - 2026-07-16 - Journal Article
Dexamethasone is Associated with a Dose-Dependent Reduction in Venous Thromboembolic Complications following Total Knee and Hip Arthroplasty.
Telang SS, Wier J, Jones IA, Lim MA, Hannon CP, Lieberman JR, Heckmann ND
Topics
Key Takeaway
High-dose perioperative dexamethasone (>16 mg) was associated with a 21% reduction in 90-day VTE odds following TKA (aOR 0.79) and a 22% reduction following THA (aOR 0.78) compared to no dexamethasone.
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Summary
This study used a national database capturing ~25% of U.S. inpatient procedures to evaluate whether perioperative dexamethasone dose on day of surgery affects 90-day VTE risk in primary TKA and THA patients from 2016–2023. Mixed-effects logistic regression demonstrated a dose-dependent VTE reduction in TKA across all dose tiers (low aOR 0.93, medium aOR 0.84, high aOR 0.79), while in THA only medium and high doses reached significance (aOR 0.85 and 0.78, respectively). The findings suggest dexamethasone's anti-inflammatory mechanism may attenuate inflammation-driven thrombogenesis in a dose-dependent fashion.
Key Limitation
The database does not capture the specific VTE chemoprophylaxis regimen (agent, dose, duration) administered to each patient, making it impossible to determine whether dexamethasone's apparent protective effect is independent of or confounded by differential prophylaxis practices across dosing groups.
Original Abstract
INTRODUCTION
Venous thromboembolism (VTE) following total knee (TKA) and hip (THA) may be mediated by postoperative inflammatory dysregulation. Emerging literature has suggested that perioperative dexamethasone may reduce the risk of VTE by mitigating inflammation-driven thrombogenesis. The present study sought to compare postoperative VTE complications across patients receiving varying perioperative dexamethasone doses.
METHODS
Using a national healthcare database that captures approximately 25% of inpatient procedures in the United States, we identified adult patients undergoing primary TKA and THA between 2016 and 2023. Patients who received dexamethasone on the day of surgery were identified and stratified into either a no dexamethasone, low-dose (less than eight milligrams [mg]), medium-dose (eight to 12 mg), or high-dose (greater than 16 mg) cohort. Outcomes were compared between the cohorts utilizing mixed-effects logistic regression. The primary outcome was the 90-day adjusted odds of VTE complications.
RESULTS
Among TKA patients (n = 946,019), 393,971 (41.7%) did not receive dexamethasone, 161,287 (17.1%) received low-dose, 310,595 (32.8%) received medium-dose, and 80,166 (8.5%) received high-dose. Among THA patients (n = 537,684), 239,671 (44.6%) did not receive dexamethasone, 80,166 (14.9%) received low-dose, 151,875 (28.3%) received medium-dose, and 66,482 (12.4%) received high-dose. Within the TKA cohort, all dosing groups had significantly lower adjusted odds of VTE compared to the unexposed patients (low dose - adjusted odds ratio [aOR]: 0.93, 95% confidence interval [CI]: 0.87 to 0.99, P = 0.020; medium dose - aOR: 0.84, 95% CI: 0.80 to 0.89, P < 0.001; high dose - aOR: 0.79, 95% CI: 0.72 to 0.88, P < 0.001) when compared to those who did not receive dexamethasone. For THA patients, the adjusted odds of VTE were significantly lower in just the medium (aOR: 0.85, 95% CI: 0.77 to 0.94, P = 0.001) and high dose (aOR: 0.78, 95% CI: 0.64 to 0.94, P = 0.009) groups.
DISCUSSION
Patients who received higher doses of dexamethasone experienced lower rates of VTE complications. Arthroplasty surgeons should consider higher doses of dexamethasone as a perioperative adjunct to standard VTE chemoprophylaxis regimens.