Impact of Preoperative Intra-articular Injection on Infection Rates Following Total Knee Arthroplasty: An Analysis of Over 19,000 Patients

Turcotte, Justin; Aja, Jacob M.; Menon, Nandakumar; MacDonald, James; King, Paul J.

doi:10.26502/josm.511500029

Cited by 3 publications

(6 citation statements)

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“…It is still controversial whether intra-articular injections before TKA increase the risk of periprosthetic joint infection (PJI). [10][11][12][13][14][15][16][17][18] Some meta-analyses of PJI were conducted after TKA or total hip arthroplasty (THA); [19][20][21] however, the results were contradictory, emphasizing the lack of evidence in existing studies.…”

Section: Introductionmentioning

confidence: 99%

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

Yang¹,

Li²,

Ren³

et al. 2022

Bone & Joint Research

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Aims There is conflicting evidence on the safety of intra-articular injections of hyaluronic acid (HA) or corticosteroids (CSs) before total knee arthroplasty (TKA). We performed a meta-analysis of the relationship between intra-articular injections and subsequent infection rates after TKA. Methods We searched PubMed, EMBASE, and the Cochrane Library for cohort studies that assessed the effect of preoperative injection of drugs into the joint cavity on the infection rate after TKA. The outcomes analyzed included the total infection rate, as well as those for different preoperative injection time periods and different drugs. Results Eight studies, including 73,880 in the injection group and 126,187 in the control group, met the inclusion criteria. The injection group had a significantly higher postoperative infection rate than the control group (risk ratio (RR) 1.16; 95% confidence interval (CI) 1.07 to 1.27; p < 0.001; I2 = 32%). For patients who received injections up to three months preoperatively, the postoperative infection risk was significantly higher than that in the control group (RR 1.26; 95% CI 1.18 to 1.35; p＜0.001; I2 = 0%). There was no significant difference in the infection rates between the four-to-six-month injection and control groups (RR 1.12; 95% CI 0.93 to 1.35; p = 0.240; I2 = 75%) or between the seven-to-12-month injection and control groups (RR 1.02; 95% CI 0.94 to 1.12; p = 0.600; I2 = 0%). Conclusion Current evidence suggests that intra-articular injections of CSs or HA before TKA increase the risk of postoperative infection. Injections administered more than three months before TKA do not significantly increase the risk of infection. Cite this article: Bone Joint Res 2022;11(3):171–179.

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Section: Introductionmentioning

confidence: 99%

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

Yang¹,

Li²,

Ren³

et al. 2022

Bone & Joint Research

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“…Of these, there were 113,032 patients in the IASI group and 256,987 patients in the control group. Nine studies investigated the time intervals between IASIs and TKA [ 4 , 15 – 17 , 19 , 25 , 27 , 31 , 32 ]. In making the diagnosis of PJI, seven studies were based on microbiologic culture results and the other seven studies relied on the relevant disease codes, such as the Current Procedural Terminology code and the International Classification of Diseases 9th Revision code regarding postoperative infections and operative procedures to address them [ 4 ].…”

Section: Resultsmentioning

confidence: 99%

“…The overall risk of bias was assessed to be low in twelve studies based on ROBINS-I assessment [ 4 , 14 – 17 , 25 , 27 , 31 – 33 , 35 , 36 ]. Moderate risk of bias was assigned to two studies [ 19 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies reported regarding the time intervals between preoperative injections and surgery [ 4 , 15 – 17 , 19 , 25 , 27 , 31 , 32 ]. With the time interval < 6 months, the pooled odds ratio was 1.19 (95% CI 0.99–1.43, p = 0.06, I 2 = 76%; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…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 ]. These inconsistencies compromised the reliability of the conclusions.…”

Section: Introductionmentioning

confidence: 99%

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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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Risk analysis of periprosthetic knee joint infection (PJI) in total knee arthroplasty after preoperative corticosteroid injection: a systematic review

Baums

Aquilina

Pérez-Prieto

et al. 2022

Arch Orthop Trauma Surg

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Impact of Preoperative Intra-articular Injection on Infection Rates Following Total Knee Arthroplasty: An Analysis of Over 19,000 Patients

Cited by 3 publications

References 0 publications

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

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

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 analysis of periprosthetic knee joint infection (PJI) in total knee arthroplasty after preoperative corticosteroid injection: a systematic review

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