Do preoperative intra-articular injections of corticosteroids or hyaluronic acid increase the risk of infection after total knee arthroplasty? A meta-analysis

Yang, Xurong; Li, Li; Ren, Xu; Nie, Lixiong

doi:10.1302/2046-3758.113.bjr-2021-0350.r1

Cited by 17 publications

(19 citation statements)

References 30 publications

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“…Patient factors associated with postoperative infection in this study reflect the TKA literature, and include chronic obstructive pulmonary disease, chronic kidney disease, poorly controlled diabetes, obesity, liver disease, and smoking. 13,[18][19][20] Our multivariate analysis results for UKA reflect more recent TKA literature from Bhattacharjee et al who found no association between CSI performed from 2 weeks to 6 months prior to TKA. Interestingly, the authors did find CSI less than 2 weeks prior to TKA was an independent risk factor for postoperative infection (OR: 2.89; p ¼ 0.04).…”

Section: Discussionsupporting

confidence: 86%

“…Patient factors associated with postoperative infection in this study reflect the TKA literature, and include -COPD, CKD, poorly controlled diabetes, obesity, liver disease, and smoking 13,18,19,20 . Our multivariate analysis results for UKA reflect more recent TKA literature from Bhattacharjee et al who found no association between CSI performed from 2 weeks to 6 months prior to TKA.…”

Section: Discussionmentioning

confidence: 98%

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Preoperative Corticosteroid Injections Are Not Associated with Deep Infection after Unicompartmental Knee Arthroplasty

et al. 2023

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Introduction: Prior to unicompartmental knee arthroplasty (UKA), corticosteroid injections (CSI) are a common non-operative treatment for arthritis. It is unclear whether CSI prior to UKA impacts the likelihood of postoperative infection. This study sought to determine if there is a time- and/or dose-dependent relationship between preoperative CSI and postoperative infection. Materials & Methods: An administrative claims database was queried for patients undergoing UKA with >1 year of pre-enrollment and follow-up. Of 31,676 patients with a UKA who met enrollment criteria, 8,628 patients had a CSI 0-3 months prior to surgery, 111 had a CSI 3-12 months prior to surgery, and 22,937 never received an injection. Overall, 246 postoperative deep infections were reported (0.8%). Time-dependent and dose-dependent relationships were modeled using multivariable logistic regressions. Results: Postoperative deep infections occurred in 64 patients with CSI 0-3 months prior to surgery (0.7%), compared with 0 patients with CSI 3-12 months before surgery (0.0%) and 182 controls (0.8%, P=0.58). CSI within 1 month prior to UKA was not statistically associated with postoperative infection (P=0.66). Two or more CSI within 3 months prior to UKA was associated with a 2-fold elevated odds of infection, compared to receiving a single injection (odds ratio 2.08, P=0.03). Univariable predictors of infection included younger age, increasing CCI, smoking, asthma, chronic obstructive pulmonary disease, chronic kidney disease, diabetes, liver disease, and obesity. Multivariable analysis controlling for these characteristics elicited no relationship between recent CSI administration and postoperative infection. CSI within 3 months of surgery (1.5%) or 3-12 months (1.8%) were associated with increased conversion to TKA compared to those who did not receive an injection (1.1%, P=0.01) although TKA for indication of periprosthetic joint infection were not statistically different (P=0.72) Conclusions: Preoperative CSI within 3 months of UKA is not associated with postoperative infection, although significant medical comorbidity does show an association. Preoperative CSI is associated with increased conversion from UKA to TKA for non-infectious indications.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 98%

Preoperative Corticosteroid Injections Are Not Associated with Deep Infection after Unicompartmental Knee Arthroplasty

et al. 2023

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“…A large database study by Cancienne et al, however, had a limitation in that the database was confined to a Medicare-only population [ 15 ], making it difficult to apply their results to the younger population [ 4 ]. Recent meta-analyses did not distinguish injected medications in assessing the risk of PJI [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies included patients who underwent knee joint arthroplasty and patients who underwent hip joint arthroplasty together in assessing the risk of PJI [ 20 – 22 ]. Some authors did not specify medications injected into the joint (corticosteroid, hyaluronic acid, or others) [ 23 , 24 ]. The previous studies have investigated the risk of PJI in the setting of various time intervals (from 4 weeks to 1 year) between preoperative injections and arthroplasty [ 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis

2023

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Objective Albeit with no disease-modifying effects, intra-articular steroid injections (IASIs) are still widely used to relieve symptoms of knee osteoarthritis. Previous literature has reported conflicting results regarding the safety of IASI in terms of periprosthetic joint infection (PJI) in total knee arthroplasty (TKA). This study tried to determine whether preoperative IASIs increased the risk of PJI, with different time intervals between the injections and surgery. Methods A computerized search of MEDLINE, EMBASE, and Cochrane Library was conducted for studies published before October 2022, which investigated the PJI rates of patients who received IASIs before TKA and patients who did not. The primary outcome was the association between preoperative IASI and PJI in TKA. The time point from which IASIs could be applied without risking PJI was also assessed. Results Fourteen studies, with 113,032 patients in the IASI group and 256,987 patients in the control group, were included. The pooled odds ratio of PJI was 1.13 (95% confidence interval [CI] 1.00–1.27, p = 0.05), indicating no increased risk of PJI. With the time interval < 6 months, the pooled odds ratio was 1.19 (95% CI 0.99–1.43, p = 0.06). However, with the time interval < 3 months, the pooled odds ratio was 1.26 (95% CI 1.06–1.50, p < 0.01). Conclusion IASI is not a safe procedure for patients who are expected to undergo TKA. The time interval between the injections and surgery was an important factor in assessing the safety of IASI. Preoperative injections that were applied within 3 months increased the risk of PJI in TKA.

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“…Yang et al reported that intra-articular injections of corticosteroid or hyaluronic acid prior to TKA increased the risk of postoperative infection. Injections given more than 3 months prior to TKA did not substantially augment the risk of infection [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty

Rodríguez-Merchán

Delgado-Martínez

2022

JCM

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Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient’s perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.

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Do preoperative intra-articular injections of corticosteroids or hyaluronic acid increase the risk of infection after total knee arthroplasty? A meta-analysis

Cited by 17 publications

References 30 publications

Preoperative Corticosteroid Injections Are Not Associated with Deep Infection after Unicompartmental Knee Arthroplasty

Preoperative Corticosteroid Injections Are Not Associated with Deep Infection after Unicompartmental Knee Arthroplasty

Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis

Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty

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