Image-Guided Intra-articular Hip Injections and Risk of Infection After Hip Arthroscopy

Abstract

Background: Although intra-articular injections are important in the management of patients who may later undergo hip arthroscopy, conflicting data are available regarding the safety of such injections when administered within 3 months of surgery. Furthermore, despite the increasing use of image-guided intra-articular hip injections, it is unknown whether the type of imaging modality used is associated with infection after hip arthroscopy. Purpose: To assess the risk of infection associated with image-guided intra-articular injections before hip arthroscopy and, secondarily, compare that risk between ultrasound (US) and fluoroscopic (FL) guidance. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective cohort study of patients in a large national insurance database who underwent hip arthroscopy between 2007 and 2017. Patients were required to have continuous enrollment from at least 1 year before to 6 months after hip arthroscopy. Patient age, sex, geographic region, medical history, surgical details, and hip injections were collected. Patients who underwent injection ≤3 months preoperatively and >3 to ≤12 months preoperatively were compared with patients who did not undergo preoperative injection. Bivariate analyses and multivariable logistic regressions were used to assess the association between ipsilateral preoperative hip injection and surgical site infection within 6 months of surgery. Results: We identified 17,987 patients (36.3% female; mean ± SD age, 37.6 ± 14.0 years) undergoing hip arthroscopy, 2276 (12.7%) of whom had an image-guided hip injection in the year preceding surgery (53.0% FL). Patients who underwent intra-articular injection ≤3 months preoperatively had similar infection rates to patients who did not undergo preoperative injection in the year before surgery for both the FL (0.46% vs 0.46%; P≥ .995) and the US cohorts (0.50% vs 0.46%; P = .76). Results persisted in adjusted analysis (FL ≤3 months: OR, 1.04; 95% CI, 0.32-3.37; P = .94; US ≤3 months: OR, 1.19; 95% CI, 0.36-3.90; P = .78). Similar results were seen for patients undergoing injections >3 to ≤12 months preoperatively. Conclusion: Postoperative infection was rare in patients undergoing intra-articular hip injection ≤3 months before hip arthroscopy and was no more common than in patients not undergoing preoperative injection. Moreover, no differences were seen in infection risk between US and FL guidance. Although intra-articular hip injections should always be administered with careful consideration, these results do not suggest that these injections are uniformly contraindicated in the 3 months preceding hip arthroscopy.

Comparing the Risk of Osteonecrosis of the Femoral Head Following Intra-Articular Corticosteroid and Hyaluronic Acid Injections

“…Because the International Classification of Diseases (ICD)-9 codes do not provide laterality, we could not confirm the laterality of ONFH. However, this bias would result in the true rates of ONFH being even lower than what was reported and it would apply to both groups, and ICD-9 codes have been used extensively to study the risks associated with intraarticular injections in orthopaedic surgery 31,32,[45][46][47][48][49][50] . As the primary injectate is frequently the only medication that is billed, we were unable to analyze the role of any concurrent anesthetic.…”

“…Similar to prior work 31,32 , we first identified all patients who received an intra-articular HAI or CSI of the hip using Current Procedural Terminology ([CPT] 20610/20611) and Healthcare Common Procedure Coding System codes (Appendix Table I). Patients with a history of osteonecrosis or those who underwent both types of injections were excluded.…”

“…Patients with a history of osteonecrosis or those who underwent both types of injections were excluded. All patients were required to be undergoing injection for a hip condition; however, to ensure that injections were not being given in another major joint, all patients with concurrent knee or shoulder pathology documented at the time of injection (n = 56) were excluded from our primary analysis 32 (Appendix Table II). Similarly, given that CSIs may be given for bursitis under the same CPT code, any patient with concurrent bursitis (n = 39) was excluded from our primary analysis 32 (Appendix Table II).…”

Arctiin-reinforced antioxidant microcarrier antagonizes osteoarthritis progression

“…Unlike other acute inflammatory joint diseases, e.g., rheumatoid arthritis (RA), gouty arthritis (GA), or psoriatic arthritis (PA), the development of OA is a gradual and slow process lasting decades. Injection-based therapies require repeated intra-articular administration, which may increase tissue damage and risk of infection [ 56 ]. The hydrogel-inspired method effectively prolong the time for the drug to take effect; however, the excessive rigidity of some hydrogels may impair the superlubricity between articular cartilage surfaces [ 57 ].…”

What’s New in Orthopaedic Rehabilitation

“…In an early study, Wang et al raised concern about injections increasing the risk of infection after hip arthroscopy 9 ; however, in a follow-up study, Byrd et al found no infections among 500 patients undergoing ultrasound-guided hip injections in the 3 months before hip arthroscopy 10 . In 2021, Varady et al published a retrospective cohort study of 17,987 patients further evaluating the infection risk of ultrasound and fluoroscopy-guided injections prior to hip arthroscopy 11 . A total of 12.7% of patients received an image-guided hip injection within the year preceding the surgical procedure.…”