The efficacy and safety of methylprednisolone for pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials

Background: Pain management after arthroplasties has become a serious problem. We perform a meta-analysis from randomized controlled trial (RCTs) to examine the efficacy and safety of methylprednisolone in the setting of postoperative pain after total knee arthroplasty (TKA). Methods: We conduct electronic searches of Medline (1966 to October 2017), Embase (1980 to October 2017), ScienceDirect (1985 to October 2017) and the Web of Science (1995 to October 2017). Eligibility criteria: (1) Participants: Published studies enrolling adult human subjects with knee osteoarthritis who prepare for TKA are included in our study; (2) Interventions: The intervention groups receive methylprednisolone in the management of postoperative pain; (3) Comparisons: The control groups receive placebo; (4) Outcomes: The primary outcomes are visual analogue scale (VAS) scores and narcotic consumption. The secondary outcomes include adverse effects (gastrointestinal events and pruritus) and postoperative complications (deep venous thrombosis, pulmonary embolism and infection); (5) Study design: RCTs. Fixed/random effect model is adopted according to the heterogeneity tested by I-2 statistic. Stata 11.0 software is used to perform the meta-analyses. Results: Four RCTs involving 248 patients are included. The present meta-analysis indicates that there are significant differences between groups regarding pain score at 6 h (WMD = -0.661, 95% CI: -1.152 to -0.171, P = 0.008), 12 h (WMD = -0.555, 95% CI: -1.091 to -0.018, P = 0.043) and 24 h (WMD = -0.648, 95% CI: -1.146 to -0.150, P = 0.011) after TKA. Significant differences are found in terms of narcotic consumption at 6 h (WMD = -3.453, 95% CI: -6.116 to -0.791, P = 0.011), 12 h (WMD = -5.138, 95% CI: -9.036 to -1.240, P = 0.010) and 24 h (WMD = -3.651, 95% CI: -5.909 to -1.393, P = 0.002). Conclusion: Methylprednisolone could significantly decrease postoperative pain score, narcotic consumption and opioid-related adverse effects after TKA. Further high-quality RCTs are still required to validate the results.