Anti-inflammatory agents after hip and shoulder arthroplasty: A systematic review and meta-analysis.

چکیده اصلی

BACKGROUND: Postoperative inflammation after arthroplasty contributes to pain, delayed mobilization and prolonged hospitalization. Recent randomized trials have evaluated pharmacological anti-inflammatory strategies within contemporary enhanced recovery pathways, but evidence after hip and shoulder arthroplasty remains scattered across different drug classes and perioperative regimens. OBJECTIVES: To synthesize recent randomized controlled trial (RCT) evidence on perioperative anti-inflammatory agents after hip and shoulder arthroplasty. METHODS: PubMed, Embase, Cochrane Library and Web of Science were searched for English-language RCTs published from January 2020 to March 2026. The 2020-2026 window was selected to update evidence generated under modern arthroplasty, anesthesia, multimodal analgesia and enhanced recovery after surgery (ERAS) pathways. Eligible trials included adults undergoing hip or shoulder arthroplasty and compared corticosteroids, cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal anti-inflammatory drug (NSAID)-based/local anti-inflammatory regimens, or related anti-inflammatory interventions with placebo, saline, no treatment, or the same regimen without the target component. Weighted mean differences (WMDs) were pooled using random-effects models. RESULTS: Nine RCTs involving 800 patients were included. Anti-inflammatory interventions significantly reduced postoperative C-reactive protein (CRP) [WMD=-32.18, 95% confidence interval (CI) (-41.16, -23.21), P<0.001], interleukin-6 (IL-6) [WMD=-31.25, 95% CI (-41.79, -20.77), P<0.001], rest pain [WMD=-0.41, 95% CI (-0.58, -0.23), P<0.001], activity pain [WMD=-0.56, 95% CI (-0.83, -0.29), P<0.001] and hospital stay [WMD=-0.54, 95% CI (-0.92, -0.15), P=0.006]. CONCLUSION: Recent RCT evidence suggests that perioperative anti-inflammatory interventions can attenuate early inflammatory responses and improve short-term pain and recovery after hip and shoulder arthroplasty. Because data were limited and clinically heterogeneous, the findings should not be interpreted as evidence favoring a specific drug class, dose, route, or timing.

ترجمه فارسی چکیده

پس از جراحی جایگزینی مفصل، التهاب پس از عمل به درد، تاخیر در تحرک و طولانی شدن بستری بیمار کمک می‌کند. هدف این مطالعه جمع‌بندی شواهد آزمایش‌های کنترل شده تصادفی (RCT) جدید در مورد عوامل ضدالتهابی در دور قبل از عمل در جراحی ران و شانه است. در این مرور، ۹ آزمایش شامل ۸۰۰ بیمار وارد شد. عوامل ضدالتهابی به طور معناداری سطح پروتئین واکنشی سی (CRP)، اینترلوکین ۶ (IL-6)، درد استراحت، درد فعالیت و مدت بستری را کاهش دادند. شواهد RCT جدید نشان می‌دهد که این مداخلات می‌توانند پاسخ‌های التهابی اولیه را مهار کرده و بهبود درد و بهبودی کوتاه‌مدت را در جراحی ران و شانه تسهیل کنند. با توجه به محدودیت داده‌ها و تنوع بالینی، نتایج نباید به عنوان شواهدی برای یک کلاس دارو خاص، دوز، مسیر یا زمان‌بندی تفسیر شوند.

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