Impact of ongoing glucocorticoid use on postoperative complications following total knee arthroplasty: a Japanese nationwide propensity score–matched cohort study

OBJECTIVES: Glucocorticoid use poses perioperative concerns in orthopaedic surgery, but its impact on postoperative outcomes following total knee arthroplasty (TKA) remains unclear. METHODS: This retrospective cohort study used the Japanese Diagnosis Procedure Combination database to evaluate postoperative complications in patients undergoing TKA between April 2016 and March 2023. Patients on continuous glucocorticoid therapy (≥5 mg/day prednisolone equivalent) were matched 1:1 with non-users using propensity score matching based on age, sex, body mass index, anaesthesia type, bilateral surgery, and Charlson Comorbidity Index. RESULTS: After matching, 12,212 patients (6106 per group) were analyzed. The glucocorticoid group had significantly higher rates of pneumonia [odds ratio (OR): 3.70, 95% confidence interval (CI): 1.89-7.26, P = .0001] and in-hospital mortality (OR: 3.59, 95% CI: 1.47-8.73, P = .005). No significant differences were observed in venous thromboembolism or surgical site infection. Male sex was also an independent risk factor for mortality. CONCLUSIONS: Ongoing glucocorticoid use is associated with an increased risk of postoperative pneumonia and in-hospital mortality following TKA. These findings highlight the need for careful perioperative management in this high-risk population.