Low-dose oral prednisolone added to celecoxib following total knee arthroplasty was associated with lower early postoperative pain, but benefits were attenuated after age adjustment and were not sustained at 24 weeks, when knee function scores favored celecoxib alone, according to a randomized clinical trial.
Researchers enrolled 102 patients aged 50 years or older undergoing primary unilateral total knee arthroplasty at three tertiary hospitals and randomly assigned them to receive celecoxib plus oral prednisolone 10 mg daily or celecoxib alone for two weeks beginning 24 to 48 hours following surgery. Ninety-nine patients were included in the final analysis.
The celecoxib-alone group was significantly older than the prednisolone group (mean age about 69 vs 65 years), a baseline imbalance that influenced adjusted analyses.
Patients who received prednisolone reported lower resting pain scores at one and two weeks compared with celecoxib alone, while pain during activity did not differ between groups. Sleep quality at two weeks, range of motion at four weeks, and knee function score at two weeks also favored prednisolone in unadjusted analyses.
However, these early differences were not robust after adjustment for age. After accounting for baseline age imbalance, differences in resting pain, sleep quality, knee function score, and range of motion were no longer statistically significant.
No sustained benefit was observed. At 24 weeks, Knee Society Score favored celecoxib alone, and Oxford Knee Score did not differ significantly between groups at any time point.
No cases of superficial wound dehiscence, surgical site infection, deep vein thrombosis, or thromboembolic events were reported in either group.
The researchers concluded that oral prednisolone may provide modest early postoperative benefit, but the observed improvements did not consistently reach minimal clinically important difference thresholds and should be interpreted cautiously given the small sample size and wide confidence intervals.
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Source: JBJS Open Access
