Intra-articular steroid injection at the time of knee arthroscopy increases risk of post-operative infection

Abstract

Purpose To evaluate the risk of post-operative infection after intra-articular steroid injection at the time of knee arthroscopy at a single institution high-volume sports medicine practice. Methods The electronic medical record at a single institution was queried for all patients who underwent knee arthroscopy from 2011 to 2019. Patients were included if they underwent more simple arthroscopic procedures: diagnostic arthroscopy, meniscectomy, loose body removal, synovectomy, or microfracture. Patients were excluded if they underwent more complex procedures, such as ligament reconstruction, meniscus repair, or any open procedures. These patients' medical records were then queried for current procedural terminology and international classiication of disease codes indicating post-operative infection. Individual chart review was performed on this group of patients to determine if a true postoperative infection occurred within 6 months of the index arthroscopy. Patients were then categorized into "intra-operative steroid injection" versus "no steroid" based on each surgeon's preferred intra-operative analgesic injection cocktail. Results A total of 6889 patients were identiied, including 2416 (35.1%) who were given intra-articular steroid at the time of knee arthroscopy. Post-operative infection occurred in 10 patients (0.15%) at a median of 18 days (range 9-42 days), 7 who received intra-operative steroid injection (0.29%) and 3 who did not (0.067%), p = 0.040. The relative risk of infection for those who received intra-operative steroid injection was 4.32 times higher than those who did not, with a number needed to harm of 448. There were no signiicant diferences in age, body mass index, smoking status, or the prevalence of diabetes between those who got infected and those who did not. Conclusions Knee infection following arthroscopic surgery is rare. Intra-operative steroid injection during arthroscopic knee surgery is associated with a 4.3-fold increased risk of subsequent knee infection. While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed. Level of evidence IV.

Corticosteroid injections 2 months before arthroscopic meniscectomy increases the rate of postoperative infections requiring surgical irrigation and debridement

“…The results of this analysis suggest that CSI is associated with an increased risk of serious infections requiring a return to the operating room and exhibits both a time-and dosedependent relationships. Corticosteroid injections administered during or shortly after surgery harbour a well-described increased risk of postoperative [28] infection [2,[6][7][8]21]. Multiple explanations for the relationship between postoperative infection and CSIs have been put forth, but no deinitive connection has been identiied.…”

“…Corticosteroid injections administered during or shortly after surgery harbour a well‐described increased risk of postoperative [28] infection [2, 6–8, 21]. Multiple explanations for the relationship between postoperative infection and CSIs have been put forth, but no definitive connection has been identified.…”

“…Given the known immunosuppressive efects of glucocorticoids, there have been an abundance of studies investigating the potential role of CSIs in postoperative infection risk [6,7,9,14,21,22,27,28]. CSIs given intraoperatively or within 4 weeks postoperatively in knee arthroscopy are associated with an increased risk for postoperative infection [6,7].…”

Corticosteroid injections for non-spinal musculoskeletal conditions: Consideration of local and systemic adverse drug reactions and side effects

“…For example, randomised clinical trial results suggest worse outcomes at one year for CSI in the treatment of tennis elbow when compared to placebo (Coombes et al, 2013). Intraarticular CSI at the time of knee arthroscopy increases the risk of post-operative infection (Kohls et al, 2022), and early findings suggest that CSI for knee osteoarthritis may contribute to worsening of the condition as reported in MRI scans (Bharadwaj, 2022) and radiography (Darbandi, 2022).…”

Perioperative steroid injection in elbow arthroscopy

“…Therefore, identifying patients who are at increased risk of this complication and investigating independent risk factors are critical [4][5][6] . One potential risk factor that has historically been described, to increase the risk of infection, is corticosteroid injection at the time of surgery 10,11 . Despite this increased risk, multiple studies have shown that a corticosteroid injection at the time of surgery may decrease postoperative pain, reducing the need for narcotics, reduce heterotopic ossification (HTO) and enhance postoperative function [11][12][13][14] .…”