Perioperative Dexamethasone Is Associated With a Reduced Risk of Periprosthetic Joint Infection Following Aseptic Revision Total Hip and Knee Arthroplasty

Background Dexamethasone has been increasingly used perioperatively for arthroplasty procedures. However, there is limited evidence on its use and safety for revision total hip (THA) and knee arthroplasty (TKA). This study sought to assess the association between perioperative dexamethasone administration and postoperative infectious complications in patients undergoing aseptic revision THA and TKA. Methods Using a national healthcare database, we identified adult patients undergoing aseptic, both-component revision THA and TKA between 2016 and 2023. Patients were stratified into those treated by high- (DEX[+]) or low-use (DEX[−]) dexamethasone surgeons using k-means clustering. Mixed-effects logistic regression was used to compare the 90-day rates of periprosthetic joint infection (PJI) and composite infectious outcomes between the DEX(+) and DEX(−) cohorts. Results In total, 35,222 patients were identified who underwent aseptic revision THA (n = 12,771) and TKA (n = 22,451). When accounting for surgeon clustering and comorbidities, DEX(+) demonstrated lower odds of PJI in revision THA (1.05% vs 3.42%, adjusted odds ratio [aOR]: 0.72, 95% confidence interval [CI]: 0.53-0.978, P = .035) and revision TKA (0.74% vs 2.87%, aOR: 0.75, 95% CI: 0.56-0.99, P = .042) as well as composite infectious outcomes in the revision THA (2.60% vs 12.15%, aOR: 0.58, 95% CI: 0.48-0.71, P < .001) and revision TKA (1.66% vs 6.90%, aOR: 0.68, 95% CI: 0.56-0.83, P < .001) cohorts. Conclusions Perioperative dexamethasone use was associated with reduced PJI and infectious risk following aseptic revision THA and TKA, supporting the routine dexamethasone administration in revision arthroplasty procedures.