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

Abstract

Background Infection after total knee arthroplasty (TKA) can result in disastrous consequences. Previous research regarding injections and risk of TKA infection have produced conflicting results and in general have been limited by small cohort size. Questions/purposes The purpose of this study was to evaluate if intraarticular injection before TKA increases the risk of postoperative infection and to identify if time between injection and TKA affect the risk of TKA infection. Methods The Humana data set was reviewed from 2007 to 2014 for all patients who received a knee injection before TKA. Current Procedural Terminology (CPT) codes and laterality modifiers were used to identify patients who underwent knee injection followed by ipsilateral TKA.Postoperative infection within 6 months of TKA was identified using International Classification of Diseases, 9 th

Do Intra-Articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review

“…In another study looking at 29,603 patients with an injection and 54,081 without, Bedard et al found a statistically signi cant increased risk of infection with an injection before surgery. When the injection cohort was strati ed into time periods, the association persisted for an injection within up to six months of surgery [11].Our study found no association of infection from injections at any time period prior to patients' TKA (Table 3). Both Cancienne's and Bedard's groups discussed the limitations of these large database studies, which included a dependence on proper coding, a lack of demographic data, and an inability to differentiate the speci c site or contents of the injections.…”

“…However, due to the underpowered and heterogeneous nature of many prior studies, both of these publications cited the need for increased larger-sized studies on the matter [14,15]. Since that time, additional studies seem to display dichotomy between relatively smaller, single center studies [16,17], such as this one, and larger database studies [9,11].…”

“…However, the available literature on this topic demonstrates con icting evidence. Several studies have reported that preoperative, intra-articular corticosteroid injections lead to an increased rate of PJI [8][9][10][11],while other studies have reported no difference in surgical outcomes [12][13][14][15][16][17]. Currently, there are no clear recommendations regarding the timing of these injections with respect to surgery.…”

Is There an Association Between Hemoglobin A1C and Deep Postoperative Infection After TKA?

“…Furthermore, while a ROC analysis determined that an HbA1c level greater than 8.0 mg/dL might serve as a threshold for an increased risk of deep postoperative infection after TKA, our AUC analysis indicated that the accuracy of this threshold as an independent predictor for postoperative infection after TKA was poor and of limited clinical utility. Our study has several limitations, many of which are inherent to all studies using large administrative databases [3,7,8]. First, the power of our analysis relies on the quality of the available data and the accuracy of procedural coding in the database.…”

The Use of Magnetic Resonance Imaging and Plain Radiographs Among Adolescents With Back Pain and Adolescent Idiopathic Scoliosis

“…This database has been used in a variety of clinical studies. [10][11][12][13] The database provides an option for longitudinal tracking based on the date of a diagnosis, procedure, imaging event, lab result and/or a prescription medication. This function was useful for our particular analysis because it allowed us to track the amount of imaging paid for by Humana insurance after the diagnosis of AIS and/or LBP.…”