Letters to the Editor   |    
Efficacy and Safety of Steroid Use for Postoperative Pain Relief
Michael D. McKee, MD, FRCS(C)1
1 St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada, e-mail: mckeem@smh.toronto.on.ca
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Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 May 01;89(5):1134-1134
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To The Editor: I would like to congratulate Mr. Salerno and Mr. Hermann on their excellent review, "Efficacy and Safety of Steroid Use for Postoperative Pain Relief. Update and Review of the Medical Literature" (2006;88:1361-1372), regarding steroid use to decrease postoperative pain. There is, however, one aspect of the use of these medications which I believe needs to be emphasized. Working in a center with an interest in osteonecrosis of the femoral head, I have seen an alarming number of young individuals with this condition following the short-term use of a steroid medication1. Often these unfortunate patients are prescribed steroids for what could be considered to be nebulous indications at best (i.e., undiagnosed skin rash or poison ivy). While the cause-effect relationship remains controversial, it is my firm belief that even short-term use of a steroid medication will, in a small but consistent percentage of patients, result in the subsequent development of (often bilateral) osteonecrosis of the femoral head—a devastating complication in a young individual. This is a fact that must be considered when deciding to administer these medications.
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