Management of Osteoarthritis with Corticosteroids

Perioperative Considerations

• The American College of Rheumatology recommends that patients taking ≥15-20 mg/day prednisone have significantly elevated infection risk following total joint arthroplasty, with an odds ratio of 1.68 for postoperative infectious complications 3
• The Centers for Disease Control and Prevention (CDC) considers 20mg/day prednisone for ≥2 weeks as the immunosuppression threshold, and optimal candidates for elective total knee arthroplasty should be on <20mg/day prednisone when possible 1, 3
• Patients on ≤16mg/day prednisone should continue their usual daily dose perioperatively rather than receiving stress-dose steroids, according to the American College of Rheumatology 2, 5, 8

Medication Management

• The American College of Rheumatology recommends discontinuing prednisone 20mg daily for osteoarthritis, as it provides no benefit and increases surgical risk 1, 3
• The American College of Rheumatology suggests tapering prednisone gradually (e.g., reduce by 5mg every 3-5 days) to avoid adrenal insufficiency if the patient has been on 20mg daily for >2 weeks 5
• The American College of Rheumatology conditionally recommends NSAIDs, such as celecoxib, for osteoarthritis pain management 6

Alternative Pain Management

• Tramadol may be considered for additional analgesia while awaiting surgery, according to the American College of Rheumatology 6
• Physical therapy may help with preoperative conditioning, although it is not mandatory to delay surgery, as recommended by the American College of Rheumatology 7