Postoperative Oral Corticosteroids for Pain Management and Recovery After Total Knee Arthroplasty: A Systematic Review
Abstract
Total knee arthroplasty (TKA) for osteoarthritis is associated with substantial postoperative pain that drives opioid use and delays recovery. Perioperative intravenous corticosteroids reduce early pain, but the role of postoperative oral corticosteroids is less clear. We aimed to evaluate the efficacy and safety of postoperative oral corticosteroids after primary TKA for osteoarthritis. This systematic review was prospectively registered on PROSPERO (CRD420261369550) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. We searched PubMed, Embase (Ovid), the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 28 April 2026 with no language or date restrictions. Randomised controlled trials of oral corticosteroids initiated within 48 hours after primary TKA versus placebo, no oral corticosteroid, or standard care were eligible for primary synthesis; quasi-randomised and non-randomised comparative studies contributed only to sensitivity or narrative analysis. Two reviewers independently screened, extracted data, and assessed risk of bias using the revised Cochrane tool for randomised trials (Risk of Bias (RoB) 2.0). Random-effects meta-analyses (DerSimonian-Laird) were performed where studies were sufficiently homogeneous, and certainty of evidence was rated with GRADE. In total, 12 studies were included: four…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 380 participants or records.
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