Preoperative Corticosteroid Injections Demonstrate a Temporal and Dose-Dependent Relationship with the Rate of Postoperative Infection Following Total Hip Arthroplasty

Forlenza, Enrico M.; Burnett, Robert; Bs, Avinaash Korrapati; Yang, JaeWon; Valle, Craig J. Della

doi:10.1016/j.arth.2021.01.076

Cited by 25 publications

(55 citation statements)

References 23 publications

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“…Finally, after reading the full text of these articles, we excluded 13 that did not meet the inclusion criteria. Ultimately, 11 studies with a total of 173,465 hip or knee arthroplasties were included in our meta-analysis [9,13,14,16,25,26,32,34,35,37,43] (Fig. 1).…”

Section: Search Resultsmentioning

confidence: 99%

“…In addition, the difference in PJI risk as a function of time between injection and arthroplasty was not conducted in previous systematic reviews and meta-analyses. Although there has been some emerging evidence from high-volume database studies that suggest injections before arthroplasty are associated with increased PJI risk [7,9,16,40], the timing evaluated in those studies has varied from 4 weeks to 6 months.…”

Section: Introductionmentioning

confidence: 99%

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Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

Lai

Cai

Lin

et al. 2021

Clin Orthop Relat Res

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Background Intra-articular injections containing a corticosteroid are used frequently, and periprosthetic joint infection is a serious complication after total joint arthroplasty. There is debate regarding whether intraarticular corticosteroid injections before arthroplasty increase periprosthetic joint infection after surgery. Questions/purposes (1) Does a previous intra-articular corticosteroid injection increase the odds of infection after subsequent hip or knee arthroplasty? (2) Does this risk vary based on how soon before the arthroplasty (such as less than 3 months before surgery) the injection is administered?Methods Using the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to July 2021, we searched for comparative studies in English on patients who received intra-articular corticosteroid injections before arthroplasty and that tracked the frequency of infection after arthroplasty. We extracted data on the risk of infection after subsequent joint arthroplasty. The keywords included "corticosteroid," "steroid," "arthroplasty," "knee replacement," and "hip replacement." Eleven retrospective, comparative studies from four countries were included, of which 10 reported the specific diagnosis criteria and oneThe institution of one or more of the authors (QZ) has received, during the study period, funding from the Natural Science Foundation of Guangdong (2015A030313353). The institution of one or more of the authors (CZ) has received, during the study period, funding from the Research Project of Innovating to Strengthen the First Hospital of Guangzhou University of Chinese Medicine (2019IIT06). Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

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Section: Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

Lai

Cai

Lin

et al. 2021

Clin Orthop Relat Res

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“…Recently, it has been suggested that the timing of injection before surgery is an important variable while assessing the risk of PJI ( 30 ). Indeed, since the pathophysiological mechanism for the heightened risk of infection with prior injections is based on the prolonged immunosuppressive effects of CS and the joint contamination caused by the injection procedure ( 15 ), it would be plausible to believe that reduced time interval between injection and surgery would increase the risk of PJI.…”

Section: Discussionmentioning

confidence: 99%

“…In one of the excluded studies, Richardson et al ( 40 ) compared the risk of PJI after TKA between those receiving multiple injections vs. those receiving single intra-articular injections before surgery and found no difference in the risk of PJI. On the other hand, Forlenza et al ( 30 ) have demonstrated a dose-dependent relationship between the number of injections and risk of PJI after THA with every unit increase in the number of injections increasing the risk of infections. These contrasting results between THA and TKA are difficult to explain especially when our meta-analysis has failed to demonstrate significant differences in complication rates between THA and TKA.…”

Section: Discussionmentioning

confidence: 99%

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

Nie¹,

Li²

2021

Front. Surg.

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Objective: The current review was designed to assess the impact of prior intra-articular injections on the risk of prosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA) with a focus on the timing of injection before surgery.Methods: The databases of PubMed, Embase and Google Scholar were searched up to 15th June 2021. All studies comparing the incidence of PJI with and without prior intra-articular injections were included. Risk ratios (RR) with 95% confidence intervals were calculated for PJI.Results: Nineteen studies were included. Both corticosteroids and hyaluronic acid injections were used before TJA in the included studies. Overall, comparing 127,163 patients with prior intra-articular injections and 394,104 patients without any injections, we noted a statistically significant increased risk of PJI in the injection group (RR 1.24 95% CI: 1.11, 1.38 I2 = 48% p = 0.002). On subgroup analysis, there was a statistically significant increased risk of PJI in the injection group in studies where intra-articular injections were administered <12 months before surgery (RR 1.18 95% CI: 1.10, 1.27 I2 = 7% p < 0.00001). Furthermore, on meta-analysis, we noted non-significant but increased risk of PJI when injections were administered 1 month (RR 1.47 95% CI: 0.88, 2.46 I2 = 77% p = 0.14), 0–3 months (RR 1.22 95% CI: 0.96, 1.56 I2 = 84% p = 0.11), and 3–6 months (RR 1.16 95% CI: 0.99, 1.35 I2 = 49% p = 0.06) before surgery.Conclusion: Our results indicate that patients with prior intra-articular injections have a small but statistically significant increased risk of PJI after TJA. Considering that PJI is a catastrophic complication with huge financial burden, morbidity and mortality; the clinical significance of this small risk cannot be dismissed. The question of the timing of injections and the risk of PJI still remains and can have a significant impact on the decision making.Systematic Review Registration: PROSPERO: CRD42021258297.

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How do pre-operative intra-articular injections impact periprosthetic joint infection risk following primary total hip arthroplasty? A systematic review and meta-analysis

Avila

Michael

Acuña

et al. 2022

Arch Orthop Trauma Surg

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Preoperative Corticosteroid Injections Demonstrate a Temporal and Dose-Dependent Relationship with the Rate of Postoperative Infection Following Total Hip Arthroplasty

Cited by 25 publications

References 23 publications

Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

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

How do pre-operative intra-articular injections impact periprosthetic joint infection risk following primary total hip arthroplasty? A systematic review and meta-analysis

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