Intra-Articular Hyaluronic Acid Injections Less Than 6 Months Before Total Hip Arthroplasty: Is It Safe? A Retrospective Cohort Study in 565 Patients

Abstract

Background: Intra-articular hyaluronic acid (IAHA) can be injected into an osteoarthritic hip joint to reduce pain and to improve functionality. Several studies report IAHA to be safe, with minor adverse effects that normally disappear spontaneously within a week. However, intra-articular corticosteroids prior to total hip arthroplasty (THA) have been associated with increased infection rates. This association has never been investigated for IAHA and THA. We aimed to assess the influence of IAHA on the outcome of THA, with an emphasis on periprosthetic joint infection (PJI). Methods: At a mean follow-up of 52 months (±18), we compared complication rates, including superficial and deep PJIs, of THA in patients who received an IAHA injection 6 months prior to surgery (injection group) with that of patients undergoing THA without any previous injection in the ipsilateral hip (control group). One hundred thirteen patients (118 hips) could be retrospectively included in the injection group, and 452 patients (495 hips) in the control group. Results: No differences in baseline characteristics nor risk factors for PJI between the 2 groups were found. The clinical outcomes in terms of VAS pain scores (1.4 vs 1.7 points, P ¼ .11), modified Harris Hip Scores (77 vs 75 points, P ¼ .09), and Hip disability and Osteoarthritis Outcome Scores (79 vs 76 points, P ¼ .24) did not differ between the injection group and the control group. Also, complications in terms of persistent wound leakage (0% vs 1.2%, P ¼ .60), thromboembolic events (0% vs 0.6%, P ¼ 1.00), periprosthetic fractures (1.7% vs 1.2%, P ¼ .65), and dislocations (0% vs 0.4%, P ¼ 1.00) did not differ. However, in the injection group there was a higher rate of PJIs (4% vs 0%, P < .001) and postoperative wound infections (9% vs 3%, P ¼ .01), compared to the control group. Conclusion: Our findings suggest that IAHA performed 6 months or less prior to THA may pose a risk for increased rates of PJI. We recommend refraining from performing THA within 6 months after IAHA administration.

Safety of intraarticular corticosteroid injection preceding hip and knee arthroplasty: a systematic review and meta-analysis amid resolving COVID-19 arthroplasty restrictions

“…Our study cohorts may have included those with undeclared confounding interventions with potential to influence PJI. These modalities may have included intraarticular synovial fluid supplementation [45], intraarticular injectable cellular therapies (such as PRP or BMAC) [46] and potentially acupuncture [47]. Additionally, the number of ICSI provided in the study period was unclear in most studies.…”

Impact of Prior Intra-articular Injections on the Risk of Prosthetic Joint Infection Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

“…Seven studies were excluded with reasons. Finally, 19 studies were included in this systematic review and meta-analysis (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

The safety of intraarticular injection prior to total hip arthroplasty: a review

“…Multiple recent studies have reported that the time interval between the IAI and the THA is an important factor with regard to the risk of infection. [29][30][31]35,38,40 However, the literature does not agree on a definitive time window after IAI when it is safe to proceed to THA.…”