Abstract
Objective To evaluate the efficacy and safety of topical glucocorticoids for total hip arthroplasty by meta-analysis. Methods A computerized search of the Cochrane Library, MEDLINE, EMBASE, and PubMed English databases, as well as Chinese Biomedical Literature Database, vipu Chinese Science and Technology Journal Database, Wanfang database, and Chinese Knowledge Net Database, was performed to include all randomized controlled trials (RCTs) regarding topical glucocorticoid therapy for postoperative bleeding after THA according to the inclusion criteria. The quality evaluation criteria of RCTs, as stated in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.5, were adopted for evaluation, and the meta-analysis was performed using RevMan 5.3. Results A total of 10 articles were included, including 1,112 patients: 566 in the topical glucocorticoid group and 546 in the control group. The transfusion rate was 8.43% for topical glucocorticoids and 30.05% for the control group (P < 0.001), and topical glucocorticoids reduced 317.89 ml total blood loss and 76.82 ml invisible blood loss, with statistically significant differences (P < 0.001). The amount of intraoperative blood loss was reduced by topical glucocorticoids, but the difference was not statistically significant (P=0.83), and the postoperative HB value was increased by topical glucocorticoids, although the difference was statistically significant (P < 0.001). The incidence of DVT and PE after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%), the difference was not statistically significant (P=0.54), and the incidence of infection after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%). The difference was not statistically significant (P=0.39). Conclusions Topical glucocorticoids can reduce the transfusion rate and blood loss in THA patients without increasing their risk of thrombosis.
Highlights
Total hip arthroplasty (THA) is widely used in many hip diseases, but its blood loss tends to be large, even requiring blood transfusion
Whether glucocorticoids can effectively reduce bleeding and transfusion in THA surgery and whether they do not increase postoperative deep vein thrombosis and pulmonary embolism remain controversial. is systematic review and meta-analysis aimed to determine whether the use of glucocorticoids in THA surgery is effective in reducing blood loss and transfusion and whether it increases the risk of deep vein thrombosis, pulmonary embolism, and other complications
Sixty-five articles were excluded by reading the title and abstract of the articles, and the remaining by reading the full text, resulting in a total of 10 randomized controlled trials (RCTs) after exclusion [12,13,14,15,16,17,18,19,20,21]
Summary
Total hip arthroplasty (THA) is widely used in many hip diseases, but its blood loss tends to be large, even requiring blood transfusion. Studies in the 1990s noted that glucocorticoids could effectively reduce surgical bleeding in THA [4]. Much literature has studied the use of glucocorticoids in THA surgery. Most believe that glucocorticoids can reduce surgical bleeding and blood transfusion in THA and do not increase the risk of DVT. There are reports that glucocorticoids are not effective in reducing surgical blood loss in THA. Whether glucocorticoids can effectively reduce bleeding and transfusion in THA surgery and whether they do not increase postoperative deep vein thrombosis and pulmonary embolism remain controversial. Is systematic review and meta-analysis aimed to determine whether the use of glucocorticoids in THA surgery is effective in reducing blood loss and transfusion and whether it increases the risk of deep vein thrombosis, pulmonary embolism, and other complications Whether glucocorticoids can effectively reduce bleeding and transfusion in THA surgery and whether they do not increase postoperative deep vein thrombosis and pulmonary embolism remain controversial. is systematic review and meta-analysis aimed to determine whether the use of glucocorticoids in THA surgery is effective in reducing blood loss and transfusion and whether it increases the risk of deep vein thrombosis, pulmonary embolism, and other complications
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