{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:50:26Z","timestamp":1787755826286,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This randomized controlled trial evaluates low-dose oral corticosteroids for improving pain and function after total knee arthroplasty (TKA), leveraging their potent anti-inflammatory effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 102 patients who underwent primary unilateral TKA were randomized to receive either 400 mg of celecoxib plus 10 mg of oral prednisolone daily or 400 mg of celecoxib alone. Oral medications started after discharge (24-48 hours after surgery) and continuing for 2 weeks. Follow-up visits were conducted at 1, 2, 4, 12, and 24 weeks postsurgery. The Visual Analog Scale, range of motion (ROM), Knee Society Score, Oxford Knee Score, and sleep quality were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Demographic data were similar, except for age, with celecoxib alone group being older (p = 0.005). The celecoxib + prednisolone group experienced significantly lower Visual Analog Scale pain scores at 1 week (mean difference [MD]: \u22120.81; 95% confidence interval [CI]: \u22121.59 to \u22120.03) and 2 weeks (MD: \u22120.99; 95% CI: \u22121.87 to \u22120.09) postoperatively. Age-adjusted results confirmed the reduction in pain with a slight difference, although it was not statistically significant. Knee function scores showed statistically significant improvement in the celecoxib + prednisolone group at 2 weeks (MD: 12.96; 95% CI: 0.21-26.13). Improvement in knee function scores was reduced by about half in age-adjusted analysis and was not statistically significant (MD: 6.25, p = 0.35). ROM demonstrated significant difference at 4 weeks (MD: 6.66; 95% CI: 0.44-12.86). Sleep quality showed significant improvement in the celecoxib + prednisolone group at 2 weeks (MD: 0.84; 95% CI: 0.05-1.64). Improvement was clinically confirmed by controlling for the effect of age with borderline significance. Uncertainty was observed due to wide CIs in some results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Oral low-dose prednisolone administered early after TKA resulted in significant reductions in pain and improvements in sleep quality, ROM, and Knee Society Score during the early postoperative period. However, these improvements did not consistently reach the minimal clinically important difference. Adjusted analyses accounting for age suggested modest benefits, but wide CIs and small effect sizes warrant cautious interpretation. To optimize dosing regimens and assess the long-term effects of oral corticosteroids in TKA recovery protocols, large-scale randomized controlled trials are necessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.25.00331","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T18:01:34Z","timestamp":1774375294000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Systemic Low Dose Corticosteroid Improves Early Postoperative Knee Function and Pain Intensity in Patients Undergoing Unilateral Total Knee Arthroplasty"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4417-9877","authenticated-orcid":false,"given":"Mohammad H.","family":"Ebrahimzadeh","sequence":"first","affiliation":[{"name":"Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-5962","authenticated-orcid":false,"given":"Reza","family":"Ganji","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6143-9373","authenticated-orcid":false,"given":"Mahdieh","family":"Samei","sequence":"additional","affiliation":[{"name":"Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1580-5480","authenticated-orcid":false,"given":"Mohsen","family":"Dehghani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4361-6971","authenticated-orcid":false,"given":"Moslem","family":"Fallah","sequence":"additional","affiliation":[{"name":"Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6256-1036","authenticated-orcid":false,"given":"Mohammad Mahdi","family":"Sarzaeem","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3344-8632","authenticated-orcid":false,"given":"Hadi","family":"Makhmalbaf","sequence":"additional","affiliation":[{"name":"Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3493-151X","authenticated-orcid":false,"given":"Shayan","family":"Zanjanian","sequence":"additional","affiliation":[{"name":"North Khorasan University of Medical Sciences, Bojnurd, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-1129","authenticated-orcid":false,"given":"Mahla","family":"Daliri","sequence":"additional","affiliation":[{"name":"Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoumeh","family":"Salari","sequence":"additional","affiliation":[{"name":"Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7795-1830","authenticated-orcid":false,"given":"Amir","family":"Kachooei","sequence":"additional","affiliation":[{"name":"Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1]]},"reference":[{"issue":"1","key":"R1-20260324","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jjoisr.2022.12.002","article-title":"What are the causes of failure after total knee arthroplasty?","volume":"1","author":"Inui","year":"2023","journal-title":"J Joint Surg Res"},{"issue":"1","key":"R2-20260324","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s13018-022-03097-2","article-title":"Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials","volume":"17","author":"Liu","year":"2022","journal-title":"J Orthop Surg Res"},{"issue":"4","key":"R3-20260324","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2106\/JBJS.20.01153","article-title":"Comparison of intravenous and periarticular administration of corticosteroids in total knee arthroplasty: a prospective, randomized controlled study","volume":"103","author":"Hatayama","year":"2021","journal-title":"J Bone Joint Surg"},{"issue":"11","key":"R4-20260324","first-page":"813","article-title":"An innovative approach to produce silicone mold-based antibiotic-loaded knee spacer for infected knee arthroplasty","volume":"12","author":"Ganji","year":"2024","journal-title":"Arch Bone Jt Surg"},{"issue":"11","key":"R5-20260324","first-page":"704","article-title":"A randomized double-blind prospective study comparing the efficacy of subperiosteal and periarticular injections of a local anesthetic for postoperative pain management after total knee arthroplasty","volume":"11","author":"Minaei","year":"2023","journal-title":"Arch Bone Jt Surg"},{"issue":"12","key":"R6-20260324","first-page":"1049","article-title":"The effect of adding corticosteroid to the periarticular injection cocktail for pain control after total hip and total knee arthroplasty: a double-blinded randomized clinical trial","volume":"10","author":"Fard","year":"2022","journal-title":"Arch Bone Jt Surg"},{"issue":"1","key":"R7-20260324","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12871-024-02530-9","article-title":"The efficacy and safety of perioperative glucocorticoid for total knee arthroplasty: a systematic review and meta-analysis","volume":"24","author":"Liu","year":"2024","journal-title":"BMC Anesthesiol"},{"issue":"3","key":"R8-20260324","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1007\/s00167-020-06039-9","article-title":"Adding corticosteroids to periarticular infiltration analgesia improves the short-term analgesic effects after total knee arthroplasty: a prospective, double-blind, randomized controlled trial","volume":"29","author":"Wang","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"2","key":"R9-20260324","doi-asserted-by":"crossref","first-page":"493","DOI":"10.3349\/ymj.2014.55.2.493","article-title":"Periarticular injection with corticosteroid has an additional pain management effect in total knee arthroplasty","volume":"55","author":"Kwon","year":"2014","journal-title":"Yonsei Med J"},{"issue":"3","key":"R10-20260324","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/papr.12740","article-title":"Efficacy of additional corticosteroid in a multimodal cocktail for postoperative analgesia following total knee arthroplasty: a meta\u2010analysis of randomized controlled trials","volume":"19","author":"Chai","year":"2019","journal-title":"Pain Pract"},{"issue":"1","key":"R11-20260324","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s13018-017-0601-4","article-title":"Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials","volume":"12","author":"Yue","year":"2017","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"R12-20260324","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1001\/jama.2024.21972","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human participants","volume":"333","year":"2025","journal-title":"JAMA"},{"issue":"2","key":"R13-20260324","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.arth.2019.09.002","article-title":"Intravenous dexamethasone injection reduces pain from 12 to 21 hours after total knee arthroplasty: a double-blind, randomized, placebo-controlled trial","volume":"35","author":"Tammachote","year":"2020","journal-title":"J Arthroplasty"},{"issue":"1","key":"R14-20260324","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1186\/s13018-023-04347-7","article-title":"Cross-cultural adaptation and validation of the Persian version of the new Knee Society Knee Scoring System (KSS)","volume":"18","author":"Mirahmadi","year":"2023","journal-title":"J Orthop Surg Res"},{"issue":"6","key":"R15-20260324","first-page":"529","article-title":"Cross-cultural adaptation and validation of the Persian version of the Oxford knee score in patients with knee osteoarthritis","volume":"39","author":"Ebrahimzadeh","year":"2014","journal-title":"Iran J Med Sci"},{"issue":"1","key":"R16-20260324","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1477-7525-7-54","article-title":"Psychometric properties of a single-item scale to assess sleep quality among individuals with fibromyalgia","volume":"7","author":"Cappelleri","year":"2009","journal-title":"Health Qual Life Outcomes"},{"key":"R17-20260324","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.ijsu.2020.07.065","article-title":"The optimal dosage, route and timing of glucocorticoids administration for improving knee function, pain and inflammation in primary total knee arthroplasty: a systematic review and network meta-analysis of 34 randomized trials","volume":"82","author":"Wu","year":"2020","journal-title":"Int J Surg"},{"issue":"6","key":"R18-20260324","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.3390\/biomedicines10061319","article-title":"AI prediction of neuropathic pain after lumbar disc herniation\u2014machine learning reveals influencing factors","volume":"10","author":"Wirries","year":"2022","journal-title":"Biomedicines"},{"issue":"8","key":"R19-20260324","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1007\/s00167-013-2776-5","article-title":"The minimal clinically important difference in the Oxford knee score and short form 12 score after total knee arthroplasty","volume":"22","author":"Clement","year":"2014","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"R20-20260324","doi-asserted-by":"crossref","first-page":"1113577","DOI":"10.3389\/fsurg.2023.1113577","article-title":"A randomized controlled study of a psycho-behavioral intervention combined with a non-benzodiazepine to improve perioperative sleep quality in patients undergoing knee arthroplasty","volume":"10","author":"Jing","year":"2023","journal-title":"Front Surg"},{"issue":"11","key":"R21-20260324","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1038\/s41577-019-0190-z","article-title":"Sleep and inflammation: partners in sickness and in health","volume":"19","author":"Irwin","year":"2019","journal-title":"Nat Rev Immunol"},{"issue":"3","key":"R22-20260324","doi-asserted-by":"crossref","first-page":"102770","DOI":"10.1016\/j.otsr.2020.102770","article-title":"Oral administration of prednisone effectively reduces subacute pain after total knee arthroplasty","volume":"107","author":"Cheng","year":"2021","journal-title":"Orthopaedics Traumatol Surg Res"},{"issue":"9","key":"R23-20260324","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.2106\/JBJS.RVW.24.00107","article-title":"Perioperative systemic corticosteroids in modern total hip and knee arthroplasty: a primer for clinical practice","volume":"12","author":"Palmer","year":"2024","journal-title":"JBJS Rev"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:53:43Z","timestamp":1787752423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00331"}},"subtitle":["A Blinded Controlled Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.25.00331","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}