Does intraarticular steroid infiltration increase the rate of infection in subsequent total knee replacements?

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

“…Whether an intraarticular injection increases the risk of infection after TKA has not been extensively studied with most data on the subject being extremely limited by small cohort size [4,5,9,15]. Only one other large database study has been performed on this subject [3]; however, limitations from a Medicare-only population, selected coding for definitions of TKA infection, and only a 3-month interval analysis of the effects of timing between injection and TKA in that report suggested the need for the further research performed here to better understand the possible association between injection and TKA infection.…”

“…Of these studies, four were underpowered given the relatively low frequency of postoperative TKA infection with only 64 to 250 patients included in the analysis, likely contributing to the discrepant results found within these studies [4,5,9,15]. Among these five studies, there was only one other large database study that had a large enough cohort to sufficiently evaluate the risk of TKA infection after intraarticular injection.…”

Ultrasound guided intra-articular ketorolac versus corticosteroid injection in osteoarthritis of the hip: a retrospective comparative study

“…Therefore, their practical utility in the management of hip OA has recently been confirmed [6,7]. However, frequent use is avoided because of an increase in the incidence of articular infection and several mechanical side effects such as cartilage breakdown and loss of articular cartilage elasticity [8,9].…”

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

“…Further research is needed with a prospective multivariate analysis to better determine the risk between preoperative intraarticular corticosteroid injections and postoperative infection in TKA. This would be a challenging study since at least 2000 patients would be needed in each cohort to show a 50% increase in infection following intraarticular corticosteroid injection [3] An alternative approach is the continued use of a meta-analysis that has the ability to improve the power of small or inconclusive studies and offers the opportunity to critically evaluate and statistically combine results of comparable studies. Studies based on insurance databases are susceptible to confounding biases that need to be kept in mind as we interpret the results.…”