What’s the Claim?
A randomized controlled trial claims to find that using systemic corticosteroids or systemic plus periarticular corticosteroids in patients undergoing TKA resulted in less pain and better early rehabilitation (range of motion, walking distance) in the first three days after surgery. We say: Don’t believe the hype.
How’s It Stack Up?
Before we justify such a blunt delivery, a little compare and contrast. Other studies have evaluated corticosteroids (whether intravenous or periarticular) as part of an analgesic protocol after TKA. In general, periarticular use of these drugs has provided no clinically important benefits. Although some RCTs have found benefits to systemic administration of corticosteroids for pain, the effect sizes have been variable (and often small), and none of the studies on the topic have been large enough to determine whether harms — such as infection — have arisen as a result of using these drugs in this way. As you know, it takes studies that are much larger to prove safety than it does to prove efficacy, so if the safety of a clinical approach is not established, one should demand larger effect sizes in terms of efficacy.