Infection in knee replacements after previous injection of intra-articular steroid

Abstract

We reviewed 231 patients who had undergone total knee replacement with an AGC (Biomet) implant over a period of 2.5 years. After applying exclusion criteria and with some loss to follow-up, there were 144 patients available for study. These were divided into two groups; those who had received intra-articular steroid in the 11 months before surgery and those who had not. There were three deep infections, all of which occurred in patients who had received a steroid injection. The incidence of superficial infection was not significantly different in the two groups. Five patients had undergone investigation for suspected deep infection because of persistent swelling or pain and all of these had received an intra-articular injection pre-operatively. We conclude that the decision to administer intra-articular steroids to a patient who may be a candidate for total knee replacement should not be taken lightly because of a risk of post-operative deep infection.

The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA?

“…Whether an intraarticular injection increases the risk of infection after TKA has not been extensively studied with most data on the subject being extremely limited by small cohort size [4,5,9,15]. Only one other large database study has been performed on this subject [3]; however, limitations from a Medicare-only population, selected coding for definitions of TKA infection, and only a 3-month interval analysis of the effects of timing between injection and TKA in that report suggested the need for the further research performed here to better understand the possible association between injection and TKA infection.…”

“…Of these studies, four were underpowered given the relatively low frequency of postoperative TKA infection with only 64 to 250 patients included in the analysis, likely contributing to the discrepant results found within these studies [4,5,9,15]. Among these five studies, there was only one other large database study that had a large enough cohort to sufficiently evaluate the risk of TKA infection after intraarticular injection.…”

“…Of these studies, two raised concern for increased infection rates after TKA in patients with previous injection [3,15]. However, given that the risk of infection after TKA is estimated to be approximately 0.8% to 3% [2,7,12,16,19], these studies are underpowered with only one of these studies having more than 100 patients with corticosteroid injections before TKA included in the analysis.…”

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

“…In addition, case reports from the past have suggested a correlation of CSI and tendon rupture [19][20][21] , which has been confirmed in multiple animal models 6,9,10,22 . Previous studies have also shown an increase in post-operative infection rates in patients who received pre-or peri-operative CSI's [23][24][25] , but recent systematic reviews and meta-analyses have challenged these claims 11,13,26,28 . Thus, not only there is a lack of consensus regarding CSI dosage, inter-injection interval, and type of corticosteroid to administer, but a body of research exists which challenges the safety of CSI's entirely.…”

Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial

“…8,22,23 Papavasiliou claimed that intra-articular steroid injections given within an year before the surgery increase risk of postoperative infection. 24 On the contrary, there are reports that the complications associated with intra-articular steroids are only rare. 25,26 We found no cases of post-operative infection at follow-up at one year.…”