Adverse Events and Their Risk Factors Following Intra-articular Corticosteroid Injections of the Ankle or Subtalar Joint

Abstract

Background: Little data exists regarding the incidence of adverse events and their associated risk factors following intra-articular corticosteroid injection of the ankle and subtalar joint. The aim of this study was to determine the complication rate associated with such injections and to identify any predictive risk factors. Methods: Adult patients who had received an intra-articular ankle or subtalar joint injection between January 2000 and April 2016 at one of 3 regional hospitals (2 level 1 trauma centers and 1 community hospital) were included. Patients with prior intra-articular injection of corticosteroid into the ankle or subtalar joint were excluded. Explanatory variables were sex, age, race, body mass index, diabetes status, tobacco use, presence of fluoroscopic guidance, location of intra-articular injection, and administering physician’s years of experience. Results: Of the 1708 patients included in the final cohort, 99 patients (5.8%) had a total of 104 adverse events within 90 days postinjection. The most prevalent types of adverse events were postinjection flare in 78 patients (4.6% of total cohort, 75% of adverse events) followed by skin reaction in 10 patients (0.6% of total cohort, 9% of adverse events). No infections were noted. Multivariable logistic regression analysis found that intra-articular injection in the subtalar ( P = .004) was independently associated with development of an adverse event. Fluoroscopic guidance was not found to be protective of an adverse event compared to nonguided injections ( P = .476). Conclusion: The adverse event rate following intra-articular ankle or subtalar joint corticosteroid injection was 5.8%, with postinjection flare being the most common complication. Infections following injection were not reported. Injection into the subtalar joint was independently associated with the development of an adverse event after intra-articular corticosteroid injection, and this was not mitigated by the use of fluoroscopic guidance. Level of Evidence: Level III, retrospective comparative study.

Staged treatment of first metatarsal osteonecrosis using a custom titanium spacer for first metatarsophalangeal joint arthrodesis: A case report and literature review✰,✰✰,★

“…While these injections appear to be a successful means of improving pain, they are not a benign treatment option. Repeat injections, especially within a short duration of time, have been shown to cause atrophy to the articular cartilage, reduce bone density, and, in the case of this report, cause the formation of a large soft tissue mass and induce osteonecrosis of the underlying bone (2,(4)(5)(6).…”

“…Corticosteroid injections for the treatment of hallux rigidus and secondary osteoarthritis is common among foot and ankle specialists, with a reported 95% of AOFAS members performing such therapies when indicated (1). While there is good evidence of the efficacy of corticosteroid injections in the foot and ankle, (2,3) there is also evidence that corticosteroid injections in the 1 st MTP joint are ineffective for long-term pain relief and come with side effects ranging from post-injection flare to cartilage degradation (2,(4)(5)(6).…”

Needling Therapies in the Outpatient Care: Adverse Effects

“…In relation to injections, Anderson et al [97] explained an incidence of 5.8% of adverse effects. Kim et al [93] introduced the incidence separately in relation with the case: 0.84% and 1.63% in relation to the patient; on the other hand, the procedure had an incidence of 0.07% and the administrated drug 0.15%.…”

“…They evaluated 110 patients (February 2016-October 2018) and concluded that the injections history and the number of them has a significative association with soft tissue calcifications. A review (January 2000-April 2016) about adverse events due to intra-articular corticosteroid injections was made by Anderson et al [97] 1.708 patients from 3 regional hospital participated: 99 patients had 104 adverse effects within 90 days post-injection. The most prevalent symptom was flare (78 patients) and 10 patients had skin reactions.…”

A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint 

“…It was not possible to determine the quality of reporting of adverse effects in this trial or whether adverse effects arose in hallux valgus and/or hallux rigidus joints. However, the reported rate of adverse effects is homogenous with the 6% rate of mild adverse effects reported by following 1,708 steroid injections into both soft tissue and joints of the foot and ankle [33]. The most common side effect reported was a steroid ' are', an acute in ammatory reaction to the steroid solution which made up 75% of the reported side effects.…”