Does Dosage or Duration of Concurrent Oral Corticosteroid Influence Elevated Risk of Postoperative Complications After Total Joint Arthroplasty?

Published:December 27, 2021DOI:



      This report seeks to clarify whether the dosage and duration of preoperative concurrent corticosteroid use influence postoperative complications after primary total joint arthroplasty (TJA).


      This retrospective single institutional study enrolled 1128 primary TJA cases, including 905 total hip arthroplasties and 223 total knee arthroplasties at a minimum 6 months of follow-up. Mean follow-up period was 51.9 ± 34.1 months (range 6-146). Of all joints, 120 joints (10.6%) were associated with chronic concurrent oral corticosteroid use. Multivariate analysis was performed to identify whether chronic concurrent oral corticosteroid use elevated the risk of postoperative complications including surgical site infection/periprosthetic joint infection, delayed wound healing, periprosthetic fracture, and implant loosening. For chronic concurrent oral corticosteroid user, we determined whether the dosage and duration of preoperative concurrent corticosteroid use influenced postoperative complications and have an effective threshold for postoperative complications using receiver operating characteristic curve analysis.


      The multivariate analysis revealed that American Society of Anesthesiologist Physical Status 3 was an independent risk factor for postoperative complications, while concurrent oral corticosteroid use was not an independent risk factor. When we compared joints with (n = 13) and without (n = 107) postoperative complications in chronic concurrent oral corticosteroid user, there was no statistical difference in the dosage (P = .97) and duration (P = .69) between the 2 groups. Area under the curve values for the oral corticosteroid dosages and duration were 0.482 and 0.549, respectively.


      This study revealed that neither dosage nor duration of concurrent oral corticosteroid use was predictive of postoperative complications after TJA. American Society of Anesthesiologist Physical Status 3 is a major factor in postoperative complications after TJA.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Devane P.A.
        • Wraighte P.J.
        • Ong D.C.G.
        • Horne J.G.
        Do joint registries report true rates of hip dislocation?.
        Clin Orthop Relat Res. 2012; 470: 3003-3006
        • Stanbury R.M.
        • Graham E.M.
        Systemic corticosteroid therapy: side effects and their management.
        Br J Ophthalmol. 1998; 82: 704-708
        • Cordero-Ampuero J.
        • de Dios M.
        What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties?.
        Clin Orthop Relat Res. 2010; 468: 3268-3277
        • Malviya A.
        • Walker L.C.
        • Avery P.
        • Osborne S.
        • Weir D.J.
        • Foster H.E.
        • et al.
        The long-term outcome of hip replacement in adults with juvenile idiopathic arthritis: the influence of steroids and methotrexate.
        J Bone Joint Surg Br. 2011; 93: 443-448
        • Mednick R.E.
        • Alvi H.M.
        • Krishnan V.
        • Lovecchio F.
        • Manning D.W.
        Factors affecting readmission rates following primary total hip arthroplasty.
        J Bone Joint Surg Am. 2014; 96: 1201-1209
        • Boylan M.R.
        • Perfetti D.C.
        • Elmallah R.K.
        • Krebs V.E.
        • Paulino C.B.
        • Mont M.A.
        Does chronic corticosteroid use increase risks of readmission, thromboembolism, and revision after THA?.
        Clin Orthop Relat Res. 2016; 474: 744-751
        • Bongartz T.
        • Halligan C.S.
        • Osmon D.R.
        • Reinalda M.S.
        • Bamlet W.R.
        • Crowson C.S.
        • et al.
        Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis.
        Arthritis Rheum. 2008; 59: 1713-1720
        • Chong R.W.
        • Chong C.S.
        • Lai C.H.
        Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties.
        Int J Rheum Dis. 2010; 13: 235-239
        • Walker P.S.
        • Soudry M.
        • Ewald F.C.
        • McVickar H.
        Control of cement penetration in total knee arthroplasty.
        Clin Orthop Relat Res. 1984; 185: 155.e64
        • Dorr L.D.
        • Wan Z.
        • Cohen J.
        Hemispheric titanium porous coated acetabular component without screw fixation.
        Clin Orthop Relat Res. 1998; 351: 158-168
        • Engh C.A.
        • Bobyn J.D.
        • Glassman A.H.
        Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results.
        J Bone Joint Surg Br. 1987; 69: 45-55
        • CDC
        NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infection in the acute care setting.
        Centers for Disease Control and Prevention, Hyattsville, MD2013 ([Accessed 06.08.2019])
        • Amanatullah D.
        • Dennis D.
        • Oltra E.G.
        • Marcelino Gomes L.S.
        • Goodman S.B.
        • Hamlin B.
        • et al.
        Hip and knee section, diagnosis, definitions: proceedings of international consensus on orthopedic infections. Proceedings of international consensus on orthopedic infections.
        J Arthroplasty. 2019; 34: S329-S337
        • Kanda Y.
        Investigation of the freely available easy-to-use software “EZR” for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Kawakami K.
        • Ikari K.
        • Kawamura K.
        • Tsukahara S.
        • Iwamoto T.
        • Yano K.
        • et al.
        Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-alpha blockers: perioperative interruption of tumour necrosis factor-alpha blockers decreases complications?.
        Rheumatology (Oxford). 2010; 49: 341-347
        • Kittle H.
        • Ormseth A.
        • Patetta M.J.
        • Sood A.
        • Gonzalez M.H.
        Chronic corticosteroid use as a risk factor for perioperative complications in patients undergoing total joint arthroplasty.
        J Am Acad Orthop Surg Glob Respir Res. 2020; 4: e2000001
        • Nugent M.
        • Young S.W.
        • Frampton C.M.
        • Hooper G.J.
        The lifetime risk of revision following total hip arthroplasty.
        Bone Joint J. 2021; 103-B: 479-485