1. In this randomized controlled trial, post-operative treatment with methylprednisolone was associated with improvements in pain management and subjective sleep quality in patients following hip arthroplasty.
2. Additionally, length of hospital stay was significantly shorter for patients who received a single steroid intervention.
Evidence Rating Level: 1 (Excellent)
Advancements in total hip arthroplasty (THA) have allowed for shorter hospital stays and better recovery outcomes. Pain after surgery continues to be a key reason for extended hospital stays and additional cost to the healthcare system. Furthermore, this pain can initiate a stress response that affects the quality of sleep, which is essential for recovery. Given its anti-inflammatory effects, corticosteroids have been hypothesized to improve both pain and sleep in post-operative patients. This study investigated the effectiveness of post-operative administration of methylprednisolone on pain and sleep quality in patients who underwent THA.
This randomized controlled trial conducted in Iran included patients older than 18 undergoing elective THA. Patients were excluded if they had a history of renal, liver, or peptic ulcer disease, diabetic neuropathy, poorly controlled diabetes or hypertension, or a recent history of corticosteroid use. Patients were randomized (n=70) to receive either 125mg intravenous methylprednisolone or normal saline. The primary outcome of the study was pain, assessed using the visual analog scale, collected in the first 24 hours of surgery, and sleep quality assessed using the Pittsburgh Sleep Quality Index, collected postoperatively at 2, 6, 12, and 24 weeks.
The results of the study demonstrated a greater improvement in sleep quality at the 2-week postoperative mark in the steroid therapy group compared to the control group. Satisfactory pain control was also significantly improved in the those who received methylprednisolone. Furthermore, the average length of hospital stay was significantly shorter in the treatment group compared to the control group. However, this study was limited by the mean patient age (44.3 years) which is significantly younger than that of average THA patients, limiting the generalizability of the study findings. Nonetheless, this study identified methylprednisolone as an effective intervention to improve sleep quality and pain management after THA.
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