Efficacy of Vitamin C as Glucocorticoid Substitute for Reducing Pain and Inflammation After Total Hip Arthroplasty: A Randomized Controlled Trial.

2025-04-10
The Journal of bone and joint surgery. American volume 107(10)
- Wenyu Jiang
- Hong Xu
- Xue Jiang
- Yujia Zhan
- Yucan Ju
- Jinwei Xie
- Zeyu Huang
- Qiang Huang
- Fuxing Pei

PubMed: 40208930
DOI: 10.2106/jbjs.24.01080

Study Design

Type: Randomized Controlled Trial (RCT)
Sample size: n = 107
Population: 107 patients (43.0% men, 56.8 ± 10.1 years of age, 100% Han Chinese) who underwent THA due to end-stage hip disease
Methods: prospective trial, randomized to receive vitamin C, dexamethasone, or neither dexamethasone nor vitamin C after surgery
Funding: Unclear

Large Human Trial

Background

Vitamin C shows strong anti-inflammatory and analgesic effects, so we explored whether it can replace glucocorticoids in reducing pain and inflammation after total hip arthroplasty (THA).

Methods

In this prospective trial, a consecutive series of 107 patients (43.0% men, 56.8 ± 10.1 years of age, 100% Han Chinese) who underwent THA due to end-stage hip disease at our medical center between January 2023 and January 2024 were randomized to receive vitamin C, dexamethasone, or neither dexamethasone nor vitamin C after surgery. The 3 groups were compared in terms of the primary outcomes of pain reported on a visual analogue scale (VAS), perioperative morphine use, and blood indices of inflammation and fibrinolysis as well as in terms of secondary outcomes of efficacy and safety.

Results

Compared with patients in the control group, those who received vitamin C or dexamethasone reported a significantly lower VAS pain score on postoperative day 1, had significantly lower perioperative morphine consumption, and demonstrated significantly lower blood levels of C-reactive protein on days 1 and 2. The 2 groups also showed a significantly lower rate of rescue analgesia on postoperative day 1 and significantly higher Harris hip scores of joint function at 2 and 12 weeks after surgery, as well as significantly smaller thigh circumference and a lower rate of swelling on the first 2 days after surgery. Either treatment was associated with a significantly lower rate of postoperative nausea and vomiting. Dexamethasone was associated with greater blood glucose levels after surgery.

Conclusions

Vitamin C may be an effective substitute for glucocorticoids for reducing morphine use and the risk of nausea or vomiting and for improving joint function after THA without side effects causing blood glucose fluctuations.

Level of evidence

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Research Insights

Vitamin C→Improved Harris Hip Score
significantly higher Harris hip scores of joint function at 2 and 12 weeks after surgery
Effect
Beneficial
Effect size
Moderate
Vitamin C→Reduced C-Reactive Protein Levels
demonstrated significantly lower blood levels of C-reactive protein on days 1 and 2
Effect
Beneficial
Effect size
Small
Vitamin C→Reduced Need for Rescue Analgesia
The 2 groups also showed a significantly lower rate of rescue analgesia on postoperative day 1
Effect
Beneficial
Effect size
Moderate
Vitamin C→Reduced Pain
Compared with patients in the control group, those who received vitamin C or dexamethasone reported a significantly lower VAS pain score on postoperative day 1
Effect
Beneficial
Effect size
Moderate
Vitamin C→Reduced Perioperative Morphine Use
had significantly lower perioperative morphine consumption
Effect
Beneficial
Effect size
Moderate
Vitamin C→Reduced Swelling
a lower rate of swelling on the first 2 days after surgery
Effect
Beneficial
Effect size
Small
Vitamin C→Reduced Thigh Circumference
significantly smaller thigh circumference and a lower rate of swelling on the first 2 days after surgery
Effect
Beneficial
Effect size
Small
Vitamin C→Reduced Vomiting Frequency
Either treatment was associated with a significantly lower rate of postoperative nausea and vomiting.
Effect
Beneficial
Effect size
Small

Adverse Events Reported

Vitamin C→blood glucose fluctuations
Vitamin C may be an effective substitute for glucocorticoids for reducing morphine use and the risk of nausea or vomiting and for improving joint function after THA without side effects causing blood glucose fluctuations.
Finding
No significant difference
Vitamin C→postoperative nausea and vomiting
Either treatment was associated with a significantly lower rate of postoperative nausea and vomiting.
Finding
Reported