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

Avila, Amanda; Michael, T.; Acuña, Alexander J.; Samuel, Linsen T.; Kamath, Atul F.

doi:10.1007/s00402-022-04375-8

Cited by 4 publications

(3 citation statements)

References 50 publications

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“…This suggests that ICSI are not associated with an increased risk for PJI. In contrast, some studies found a higher PJI risk following ICSI, especially if the injection was performed within a 3 months interval before THA [ 19 , 20 , 22 , 55 ]. It has also been suggested by Chambers et al that multiple-injected joints were associated with higher PJI rates than single-injected joints [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that ICSI increase the risk of PJI for subsequent THA. Some studies found higher PJI rates if ICSI was performed within 3 months prior to total hip arthroplasty (THA) [ 19 – 22 ]. It has also been suggested that higher corticosteroid doses and multiple injections may result in a higher risk of PJI [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

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How safe are intra-articular corticosteroid injections to the hip?

Streck,

Braun,

Spilo

et al. 2023

BMC Musculoskelet Disord

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Background Intra-articular corticosteroid injections (ICSI) are an effective symptomatic treatment for osteoarthritis of the hip. However, the safety of ICSI has been questioned and a relatively high risk for septic arthritis, rapidly progressive osteoarthritis (RPIO) and periprosthetic joint infections (PJI) in patients undergoing subsequent total hip arthroplasty (THA) have been suggested. Methods This is a retrospective evaluation of 682 hips that underwent ICSI with 40 mg of Triamcinolone for primary osteoarthritis of the hip. All ICSI were performed using sterile techniques, the number of ICSI in each hip and the cumulative corticosteroid dosage were assessed. Pre- and post-injection radiographs were compared to identify cases with RPIO. Native joint septic arthritis, surgical site infections and PJI were identified by chart review. Results 4 hips (0.6%) developed RPIO 2–4 months following ICSI. The cumulative Triamcinolone dose was not associated with the development of RPIO (p = 0.281). 1 case was diagnosed with septic arthritis and treated with staged THA, there were no signs of infection at a 5 years follow-up. 483 hips (75.7%) underwent THA, including 199 hips with THA less than 3 months following ICSI and 181 hips with > 1 ICSI prior to THA. There were 3 superficial surgical site infections/wound dehiscence and no PJI. Conclusion The rate of RPIO was 0.6%. The current findings suggest that if ICSI is performed under sterile conditions, the risk for septic arthritis or PJI following THA, even in patients with multiple ICSI or ICSI within 3 months prior to surgery, is minimal.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How safe are intra-articular corticosteroid injections to the hip?

Streck,

Braun,

Spilo

et al. 2023

BMC Musculoskelet Disord

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“…Patients are considered high risk of PJI if they have 1 or more risk factor for infection 13 . Risk factors include obesity 14,15 , diabetes 15 , tobacco use 15 , autoimmune disease 13 , immunodeficiency 16 , injection drug use 17 , injection to the joint (e.g., anesthetics, corticosteroids, or hyaluronic acid) within the previous 3 months 18,19 , nasal colonization 20 , and prolonged operative time 21 . Although numerous risk factors have been identified for PJI, only a subset of these may be modifiable 22 .…”

Section: Oral Pji Prophylaxismentioning

confidence: 99%

The Use of Oral Antibiotics After Total Joint Arthroplasty

Tidd,

Pasqualini,

McConaghy

et al. 2023

JBJS Reviews

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» There is conflicting and insufficient evidence that extended oral antibiotic (EOA) therapy prevents infection in high-risk patients undergoing primary total joint arthroplasty (TJA), limiting recommendation for or against the practice.» In the case of aseptic revision TJA, the evidence is also conflicting and limited by underlying confounders, preventing recommendation for use of EOA.» There is fair evidence that use of EOA after debridement antibiotic therapy and implant retention of the prosthesis prolongs infection-free survival, but randomized controlled trials are needed. On the other hand, there is strong evidence that patients undergoing 2-stage revision should receive a period of suppressive oral antibiotics after the second stage.» The optimal duration of EOA in primary TJA, aseptic revision, and debridement antibiotic therapy and implant retention of the prosthesis is unknown. However, there is strong evidence that 3 months of EOA suppression may be appropriate after reimplantation as part of 2-stage exchange arthroplasty.» Complications secondary to EOA are reported to be between 0% and 13.7%, yet are inconsistently reported and poorly defined. The risks associated with antibiotic use, including development of antimicrobial resistance, must be weighed against a possible decrease in infection rate.

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Periprosthetic Joint Infection

Patel

2023

N Engl J Med

104

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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

Cited by 4 publications

References 50 publications

How safe are intra-articular corticosteroid injections to the hip?

How safe are intra-articular corticosteroid injections to the hip?

The Use of Oral Antibiotics After Total Joint Arthroplasty

Periprosthetic Joint Infection

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