Intra-articular steroids after arthroscopy for osteoarthritis of the knee

Gosal, H. S.; Jackson, Allen; Bickerstaff, D. R.

doi:10.1302/0301-620x.81b6.10218

Cited by 17 publications

(6 citation statements)

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“…Marmor et al [21] reported a paradoxically higher proportion of lawsuits for septic arthritis after arthroscopy (42%) than after arthroplasty (27%) after analysis of insurance data. The authors identified several risk factors such as irrelevant indications (especially diagnostic arthroscopy) and also the use of intraoperative corticosteroids, which they advise against [6,15]. Although 2 cases of septic arthritis after corticosteroid injection during an arthroscopy were observed in our series of cases, there were 13 cases of septic arthritis after diagnostic arthroscopy or arthroscopic lavage.…”

Section: Discussionmentioning

confidence: 82%

Litigation in arthroscopic surgery: a 20-year analysis of legal actions in France

Pioger

Jacquet

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The main objective of this study was to identify the epidemiological characteristics of litigation following arthro-scopic procedures, performed in private practice and public hospitals in France. The secondary objective was to establish a risk profile for medical malpractice lawsuits after arthroscopic surgery. Methods All court decisions related to arthroscopic surgery between 1994 and 2020 were collected and reviewed cases from the two main French legal databases (Legifrance and Doctrine). Data were retrospectively collected and included: gender, joint and defendant's specialty involved, reason behind the lawsuit, initial indication and the type of arthroscopic procedure performed. The final verdicts as well as the indemnity awarded to the plaintiff (if any) were recorded. Results One-hundred eighty cases met the inclusion criteria of the study and were analyzed: 58 cases were before administrative courts and 122 were before civil courts. An orthopaedic surgeon was involved alone or in solidum in 45.6% of cases (82/180), followed by anesthesiologists in 5.6% (10/180). The private surgery center or public hospital were implicated in 63.9% (115/180) of cases. The 2 most common joints involved in litigation following arthroscopic surgery were the knee (82.2%, n = 148) and the shoulder (11.1%, n = 20). The main reasons behind the lawsuit were related to postoperative infection in 78/180 cases and to a musculoskeletal complication in 45/180 cases (25%). A failure to inform was also reported in 34/180 cases (18.9%). Of the 180 cases, 122 cases (67.8%) resulted in a verdict for the plaintiff. The average indemnity award for the plaintiff was 77.984 euros [2. 282-1.117.667]. A verdict for the plaintiff was significantly associated with postoperative infection or a wrong-side surgery, while technical error and musculoskeletal complications were more significantly likely to result in a verdict in favor of the defendant (p = 0.003). Conclusion This study evaluated and mapped lawsuits following after arthroscopic surgery in France over a period of more than 20 years. The main joint involved in lawsuits was knee. The main causes of lawsuits following arthroscopic surgery were related to postoperative infection, musculoskeletal complications and failure to inform. Level of Evidence Level IV.

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Section: Discussionmentioning

confidence: 82%

Litigation in arthroscopic surgery: a 20-year analysis of legal actions in France

Pioger

Jacquet

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…[20] Long-term and repeated intra-articular steroid injections may lead to serious side effects of systemic steroids. [21–23] The most feared consequence is steroid-induced arthropathy and joint sepsis. [22425] Every injection causes some degree of anxiety to the physicians performing it.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis

Beyaz

2012

J Anaesthesiol Clin Pharmacol

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Introduction:Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population.Materials and Methods:Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients.Results:After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS) scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups.Conclusion:Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.

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“…The use of intraoperative intra-articular steroids has been discussed frequently as a risk factor for infection [15,24]. Many possible explanations have been offered, including that this use of steroids decreases the organism burden required for infection, that it decreases pain and so masks early signs of infection and permits premature mobilization, and that it delays healing and therefore allows a longer time for ingress of organisms through the portals [24,28]. Other authors have not confirmed the association [13].…”

Section: Risk Factors For Infectionmentioning

confidence: 99%

“…Most of the studies reviewed here, however, did not discuss the use of antibiotic prophylaxis [6,8,9,11,12,14,16,22,24,[26][27][28] or reported that either all [10,17,25] or none [13] of the infected patients received it. Wieck et al [18] attempted to address the issue of the use of antibiotic prophylaxis by performing a randomized, placebocontrolled, double-blinded trial of 437 patients, and they found no deep infections, although the sample size was small.…”

Section: Risk Factors For Infectionmentioning

confidence: 99%

Postarthroscopy Surgical Site Infections: Review of the Literature

Babcock¹,

Matava

Fraser³

2002

Clinical Infectious Diseases

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The use of arthroscopy for both diagnosis and operative intervention has been increasing steadily since its introduction in the 1970s. It is generally associated with fewer complications and shorter times to mobilization than are open procedures. Overall reported rates of complications are low (0.1%-0.6% of procedures). This review focuses on infectious complications of arthroscopy, which are rare (0.01%-0.48% of procedures) but result in significant morbidity for the patient when they occur. The most commonly reported causative organisms are staphylococci. Several outbreaks have been reported related to breaks in infection control or to contaminated instruments. Suggested risk factors include use of intra-articular corticosteroids, prolonged tourniquet time, patient's age >50 years, failure to prepare the surgical site again before conversion to arthrotomy, procedure complexity, and a history of previous procedures. However, most reports use variable and unclear definitions of infection, which makes it difficult to draw firm conclusions.

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Intra-articular steroids after arthroscopy for osteoarthritis of the knee

Cited by 17 publications

References 0 publications

Litigation in arthroscopic surgery: a 20-year analysis of legal actions in France

Litigation in arthroscopic surgery: a 20-year analysis of legal actions in France

Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis

Postarthroscopy Surgical Site Infections: Review of the Literature

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