Good Morning.

There is much coverage on total knee arthroplasty pain management strategies in the scientific literature. 

But one less explored option is the use of oral corticosteroids. IV formulations are well studied, but there is little evidence on oral formulations.

In this edition of The Pulse, we highlight a recent RCT to enlighten the topic!

In today's edition:

🏥 Oral dexamethasone for pain after TKA

📰 A changing tide in drug development methods

🎙️ Microagressions in the OR, with Dr Saroo Sharda

The use of intravenous corticosteroids is not uncommon for managing pain after total knee arthroplasty (TKA). But could an oral formulation, which has a comparably high bioavailability relative to the IV formulation and is better suited for ambulatory settings, provide comparable and sufficient pain management?

150 patients scheduled for primary unilateral total knee arthroplasty were randomized to receive either 16 mg of oral dexamethasone, 8mg of oral dexamethasone, or a placebo. The treatments (or placebo) were administered once daily the morning before surgery and the first 4 post-op days. The primary outcome of interest was pain intensity at rest and during motion, assessed up to 6 weeks post-operation.

• The 16mg group showed roughly 50% lower pain scores during the first 48 hours post-operation, both at rest and during motion, compared to placebo. Pain levels were similary by post-operative day 3. The 8mg group only showed lower pain scores vs. placebo at rest.

• The rate of post-operative nausea and vomiting were not significantly different between the three groups. 

• Both dosage groups exhibited lower rates of opioid consumption vs. placebo, although only the 8mg group showed statistically significant differences.

• Fasting blood sugar was higher in the 16mg group compared to the placebo group, while CRP levels were 3x lower than the placebo group.

• Functional outcomes, were similar across all groups, and no superficial wound complications were observed.

Bottom line. Oral dexamethasone was able to provide effective pain relief after TKA, with the 16mg dose providing the greatest reduction.

Read the full ACE Report on this study here.

With the FDA increasingly shifting biomedical research away from animals, could the future of drug development be animal free?

This is the message in a recent editorial by Rob Volansky from Healio, which discussed the new advances in new approach methodologies (NAMs) -- like AI and in vitro strategies -- are facilitating the move away from animal-based testing.

However, researchers are aware that transitioning away from animal testing too quickly might introduce serious risks due to the over-reliance of black-box predictions and biases associated with these methods.

Read the full story here.

What happens when a passing comment, a glance, or a casual joke carries more weight than intended? 

In this episode of OrthoJoe, Marc and Mo sit down with Dr Saroo Sharda, Associate Dean of Equity and Inclusion in the Faculty of Health Sciences at McMaster University, for a conversation about microaggressions in medicine.

A central theme is that harm can be real even without malicious intent, with repeated experiences contributing to isolation, burnout, and broader health consequences. The discussion also turns practical, emphasizing recognition, attention to hierarchy and power, thoughtful responses in the moment, follow-up support afterward, and the need to treat inclusive communication as a skill that must be practiced deliberately.

Watch the full podcast here.

Effect Modifiers of Graded Sensorimotor Retraining for Chronic Low Back Pain: A Secondary Analysis of the RESOLVE Randomized Trial – In adults with chronic non-specific low back pain, does graded sensorimotor retraining compared to sham and attention control have the same effectiveness on pain intensity and disability? (Read)

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Ultrasound-Guided Capsule-Preserving Hydrodilatation for Primary Frozen Shoulder Using 5% Dextrose Water vs. Corticosteroid: a Randomized Controlled Trial – In adults with primary frozen shoulder, does ultrasound-guided hydrodilatation with 5% dextrose water compared to corticosteroid-based hydrodilatation improve pain, disability, and shoulder range of motion? (Read)

Intraoperative Load Sensors vs Manual Balancing in Total Knee Arthroplasty: a Meta-Analysis – In patients undergoing primary total knee arthroplasty for osteoarthritis, does intraoperative sensor-guided soft tissue balancing compared with conventional manual balancing improve functional outcomes, range of motion, and complication rates? (Read)

Thanks for reading!

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