Abstract
PURPOSE: This study aimed to evaluate the efficacy and safety of perioperative intravenous dexamethasone (Dexa) in patients with type 2 diabetes mellitus (T2DM) undergoing total hip arthroplasty (THA). METHODS: In this prospective, single-blind randomized trial (Registration No.: MR-45-23-047982; Registration Date: December 7, 2023), 60 T2DM patients undergoing THA were assigned to either the Dexa or control group. Outcomes included white blood cell count (WBC), C-reactive protein (CRP), visual analogue scale (VAS) scores, blood glucose, nausea and vomiting, medication requirements, complications, and hospital stay. RESULTS: Compared with controls, the Dexa group had lower WBC on postoperative days 2 ~ 3 (day 2: 9.20 ± 1.28 vs.10.56 ± 2.34 × 10(9)/L, P = 0.007; day 3: 8.02 ± 1.34 vs. 9.22 ± 1.49 × 10(9)/L, P = 0.002)and reduced CRP on days 1 ~ 3 (day 1: 38.20 vs. 63.50 mg/L, P = 0.040; day 2: 86.00 vs. 101.50 mg/L, P = 0.010; day 3: 78.00 vs. 95.20 mg/L, P = 0.044). Transient hyperglycemia was observed in the Dexa group on postoperative day 1, with higher median blood glucose (8.90 vs. 8.35 mmol/L, P < 0.01) and peak glucose (11.80 vs. 10.35 mmol/L, P = 0.031) but showed no differences thereafter. VAS pain scores at rest and during activity were lower in the Dexa group on postoperative days 1 ~ 2 (all P < 0.01). Dexa reduced the need for rescue tramadol (4 vs. 12 patients, P = 0.020) and metoclopramide (1 vs. 8 patients, P = 0.026), and lowered PONV incidence (3.33% vs. 23.30%, P = 0.026). Hospital stay was shorter in the Dexa group (5.67 ± 1.13 vs. 6.70 ± 1.29 days, P = 0.002), with no differences in 90-day complications (all P > 0.05). CONCLUSION: Perioperative Dexa administration improves early recovery outcomes in patients with T2DM undergoing THA without compromising short-term safety, although it may cause transient hyperglycemia. However, the relatively small sample size, limited follow-up period, and lack of systematic evaluation of potential complications highlight the need for larger, longer-term studies to further strengthen these observations.