Do Intra-Articular Steroid Injections Increase Infection Rates in Subsequent Arthroplasty? A Systematic Review and Meta-Analysis of Comparative Studies

Charalambous, Charalambos Panayiotou; Prodromidis, Apostolos D.; Kwaees, Tariq A

doi:10.1016/j.arth.2014.07.013

Cited by 61 publications

(65 citation statements)

References 16 publications

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“…In particular, no increased risk of infection was found with the addition of corticosteroid and, notably, none of the 1,271 patients included in the review experienced tendon rupture 15 . Other studies have shown similar results, namely that the addition of corticosteroid to peri-operative local injection results in improved pain levels and does not increase post-operative complications 12,14,16,17,26,27 . The significant improvement in post-operative functional outcomes following pre-operative CSI found in this study support similar conclusions, applied to PTRCT arthroscopic repair.…”

Section: Discussionsupporting

confidence: 61%

“…In addition, case reports from the past have suggested a correlation of CSI and tendon rupture [19][20][21] , which has been confirmed in multiple animal models 6,9,10,22 . Previous studies have also shown an increase in post-operative infection rates in patients who received pre-or peri-operative CSI's [23][24][25] , but recent systematic reviews and meta-analyses have challenged these claims 11,13,26,28 . Thus, not only there is a lack of consensus regarding CSI dosage, inter-injection interval, and type of corticosteroid to administer, but a body of research exists which challenges the safety of CSI's entirely.…”

Section: Discussionmentioning

confidence: 99%

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Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Donohue

Prisco

Grindel

2017

MLTJ

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SummaryBackground: Subacromial corticosteroid injections (CSI's) are a common non-surgical treatment for rotator cuff tears. Few studies have assessed the effects of pre-operative CSI's on postoperative functional outcomes. Methods: A retrospective analysis was conducted of 132 patients with high-grade, partial-thickness rotator cuff tears (PTRCT's). The subjects were divided into two groups based on whether they received a CSI or not. The CSI group was further divided into three subgroups based on when they received a pre-operative injection: 0-3 months, 3-6 months, >6 months before surgery. The Visual Analog Scores (VAS), American Shoulder and Elbow Surgeon scores (ASES), and Constant scores were recorded prior to surgery and at a one-year post-operative follow-up appointment for each subject. Results: Patients who received a pre-operative CSI (n=92) improved significantly more than the non-injection group (n=40) in all outcome measures. The 0-3 months injection subgroup experienced a significant increase in ASES and Constant score (p=0.019 and 0.014, respectively) compared to the other two subgroups, but the VAS score decrease only trended toward significance (p=0.091). The sample as a whole experienced significant improvement in all three outcome measures. Conclusion: Patients undergoing arthroscopic repair of a high-grade PTRCT may benefit from a pre-operative CSI 0-3 months before surgery. Level of evidence: IIb.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Donohue

Prisco

Grindel

2017

MLTJ

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“…Surgeons have expanded their use of corticosteroids to local injections in a multimodal effort to control postoperative pain . Addition of corticosteroid to local infiltration analgesia has been shown to be safe and appears to be a logical approach in reducing inflammation and improving pain control . However, it remains inconclusive whether this addition is necessary and as effective as intravenous corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

et al. 2019

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Background Local injection of a multimodal cocktail including corticosteroid is commonly used for postoperative pain following total knee arthroplasty (TKA). However, it is inconclusive whether additional corticosteroid is beneficial. This meta‐analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy of an additional, local injection of corticosteroid in terms of pain relief and knee function recovery after TKA. Methods RCTs in electronic literature databases including PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Of 1,628 records identified, 9 RCTs involving 727 knees were eligible for data extraction and meta‐analysis. Results Local injection of a multimodal cocktail including corticosteroid did not contribute to pain relief within 12 hours postoperatively (P > 0.05). However, from 24 hours to 72 hours, it significantly decreased pain scores (P < 0.05, all) at rest and reduced total rescue opioid consumption postoperatively (P < 0.05). Knee range of motion (ROM) was improved at postoperative day 1 (POD1) and POD2 (P < 0.05), and hospital stay (P < 0.05) was shortened after local injection of corticosteroid. However, the other outcomes, including knee ROM after POD2, C‐reactive protein level, Knee Society score, postoperative nausea and vomiting, and wound complication occurrences, were not significantly different (P > 0.05, all). Conclusions Additional corticosteroid added to a multimodal cocktail improved postoperative pain, enhanced knee functional recovery, and shortened hospital stays following TKA, but local injection of corticosteroids had no effect on reducing nausea and vomiting based on our outcomes.

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“…Many articles have reported local injection of corticosteroids and have demonstrated their efficacy and safety in total joint arthroplasty . Two meta‐analyses also suggested that steroids added to local infiltration analgesia could improve the pain control effect and can be highly safe . Although intravenous corticosteroids in total joint arthroplasty have been studied in many trials, their outcomes vary, and judging their practical value is difficult.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intravenous Corticosteroids on Pain Management and Early Rehabilitation in Patients Undergoing Total Knee or Hip Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Wang

Yang

et al. 2017

Pain Practice

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Do Intra-Articular Steroid Injections Increase Infection Rates in Subsequent Arthroplasty? A Systematic Review and Meta-Analysis of Comparative Studies

Cited by 61 publications

References 16 publications

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Efficacy of Additional Corticosteroid in a Multimodal Cocktail for Postoperative Analgesia Following Total Knee Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

Effect of Intravenous Corticosteroids on Pain Management and Early Rehabilitation in Patients Undergoing Total Knee or Hip Arthroplasty: A Meta‐Analysis of Randomized Controlled Trials

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