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

Nie, Fei; Li, Wei

doi:10.3389/fsurg.2021.737529

Cited by 11 publications

(7 citation statements)

References 41 publications

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“…Although previous systematic reviews have evaluated the association between pre‐operative IAIs and the risk of PJI, these analyses have been underpowered [10, 43], failed to segregate total hip and total knee arthroplasty patients [9, 26], or did not report on the time frames between injection and primary TKA [22]. Notably, Nie and Li [27] recently conducted a similar study among total joint arthroplasty (TJA) patients receiving pre‐operative intra‐articular injections. However, as their 3‐month sub‐analysis was comparatively underpowered, they failed to identify an increased PJI risk within this pre‐operative interval.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular injection receipt within 3 months prior to primary total knee arthroplasty is associated with increased periprosthetic joint infection risk

Avila

Acuña

Michael

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThis systematic review and meta‐analysis analyzed the influence of pre‐operative intra‐articular injections (IAI) on periprosthetic joint infection (PJI) rates after primary total knee arthroplasty (TKA). MethodsStudies published between January 1st, 2000 and May 1st, 2021 evaluating PJI rates among TKA patients with and without IAI were identified from PubMed, Cochrane Library, MEDLINE, EBSCO Host, and Google Scholar. The pooled effect of IAI on PJI risk was calculated utilizing Mantel–Haenszel (M–H) models. Sub‐analysis comparisons were conducted based on the interval from IAI to TKA: 0–3 months; > 3–6 months; > 6–12 months. The Methodological Index for Non‐Randomized Studies (MINORS) and the Risk of Bias in Non‐randomized Studies‐of Interventions (ROBINS‐I) tool were utilized to evaluate the quality of each included study. ResultsThe present analysis included 12 studies reporting on 349,605 TKAs (IAI: n = 115,122; No IAI: n = 234,483). Patients receiving an IAI at any point prior to TKA (2850/115,122; 2.48%) had statistically significant increased risk of infection compared to patients not receiving IAIs (4479/234,483; 1.91%; OR: 1.14, 95% CI: 1.08–1.20; p < 0.0001). However, this finding was not demonstrated across sensitivity analyses. Receiving injections within 3 months prior to TKA was associated with increased infection risk (OR: 1.23, 95% CI: 1.14–1.31; p < 0.0001). There were no differences in infection rates when injections were given between > 3 and 6 months (OR: 0.82, 95% CI: 0.47–1.43; p = 0.49) and > 6–12 months prior to TKA (OR: 1.26, 95% CI: 0.89–1.78; p = 0.18). ConclusionsBased on the current literature, the findings of this analysis suggest that patients receiving IAI should wait at least 3 months before undergoing TKA to mitigate infection risk. Orthopaedic surgeons and patients can utilize this information when undergoing shared decision‐making regarding osteoarthritis management options and timing. Level of evidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Intra-articular injection receipt within 3 months prior to primary total knee arthroplasty is associated with increased periprosthetic joint infection risk

Avila

Acuña

Michael

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…When THA is performed in patients who have received a steroid injection within 3 months, researchers have found an association with increased risk of periprosthetic joint infection. Such findings suggest that injected patients should delay THA for at least 3 months after the injection, prolonging the treatment process due to the unnecessary use of an injectable [45,53,60]. Thus, the decision to inject an unfit patient results from a lack of education and incomplete understanding of the risk of inappropriate injection.…”

Section: Discussionmentioning

confidence: 99%

Non-operative Treatment Options for Osteoarthritis in the Hip

Nicholas,

Cheng,

Moley

2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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With the increased disability associated with osteoarthritis (OA) progression, and the significant socioeconomic burden of joint replacement surgeries, there is a need for more reliable conservative treatments for patients presenting with hip OA. Most studies of OA treatments involve the knee. We conducted a literature search and reviewed non-operative hip OA treatment recommendations by the Osteoarthritis Research Society International, the American College of Rheumatology, American Academy of Orthopedic Surgeons, and European Alliance of Associations for Rheumatology, as well as Cochrane Reviews. Non-steroidal anti-inflammatory drugs and corticosteroid injections are the most supported and recommended options for hip OA; other medications with potential benefits for short-term pain relief include acetaminophen and tramadol. Most societies recommend against the use of glucosamine, typical opioids, and viscosupplementation injections. Platelet-rich plasma has potential benefits, but evidence of its effectiveness is incomplete. Further research is needed to better inform and guide clinicians who create treatment plans for patients with symptomatic hip OA.

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“…42 A recent systematic review showed a statistically significant increased risk of prosthetic joint infection with administration of intra-articular injections <12 months before surgery. 43 Specifically to shoulder arthroplasty, patients who receive corticosteroid injection <3 months prior to anatomic or reverse shoulder arthroplasty were reported to have a significantly increased risk for revision. 44 Sleep apnea could have a negative impact on bone mineralization, cognition, and immunity and increases the overall rate of medical postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

Razmjou

Christakis

Nam

et al. 2023

Journal of Shoulder and Elbow Arthroplasty

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Purpose The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were “ready” and those who were “not-ready” to have surgery. Gender ( P = 0.037), overall health ( P = .024), strength in external rotation ( P = .002), pain severity ( P = .001), ASES score ( P < .0001), and expectations ( P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.

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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

Cited by 11 publications

References 41 publications

Intra-articular injection receipt within 3 months prior to primary total knee arthroplasty is associated with increased periprosthetic joint infection risk

Intra-articular injection receipt within 3 months prior to primary total knee arthroplasty is associated with increased periprosthetic joint infection risk

Non-operative Treatment Options for Osteoarthritis in the Hip

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

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