Methylprednisolone after shoulder arthroplasty leads to decreased opioid prescriptions without an increased risk of infection: A matched cohort analysis

Background: Due to the increasing demand for total shoulder arthroplasty, safe opioid stewardship paired with appropriate pain management is imperative for long-term patient care. A recent study has shown the potential for methylprednisolone use in the peri-operative period in order to decrease opioid consumption postoperatively. Methods: The large TriNetX database was queried to identify all patients who were methylprednisolone naïve that underwent total shoulder arthroplasty with a minimum follow-up of 3 months. These patients were then further separated into two cohorts – those who received post-operative methylprednisolone within 7 days of the arthroplasty procedure and those who did not. After 1:1 propensity score matching, 1304 patients were included in each cohort for analysis. The primary outcome was opioid prescription within the 30- and 90-day postoperative period. Additional hospitalization, surgical, and medical outcomes were analyzed at 30-day, 90-day, 1-year, and 2-year time points. Results: For patients who received methylprednisolone, there were significantly fewer opioid prescriptions at 30 days (1.4 ± 1.6 versus 1.5 ± 1.8, p = 0.033) and 90 days (1.8 ± 2.3 versus 2.0 ± 3.4, p = 0.026). At both 30 and 90 day time points, there was no significant difference in the risk for medical complications like acute kidney injury, deep venous thrombosis, myocardial infarction, pulmonary embolism, pneumonia, urinary tract infection, glucose values, and A1C. between the two groups. At 1 year and 2 year time points, there was no significant difference in the risk of surgical complications like need for revision, prosthetic joint infection, surgical site infection, dislocation, wound complications, mechanical failure, periprosthetic fracture, and polywear/osteolysis. Conclusion: Methylprednisolone use in the peri-operative period may lead to a decrease in the number of opioid prescriptions needed for patients post-operatively with no increased risk of surgical or medical complications. As opioids carry their own inherent risks, safe stewardship with multimodal pain regimens that include methylprednisolone may be beneficial in both the short and long term for patients. Level of evidence: Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.