Infection in hip arthroplasty after previous injection of steroid

Abstract

Immunosuppression following intra-articular injections of steroid into the hip may interfere with asepsis in a subsequent total hip arthroplasty (THA). We have undertaken a retrospective, matched, cohort study of infective complications after THA, in 40 patients who had received such an injection and 40 who had not. In the injection group there were five revisions, four of which were for deep infection. There were none in the matched group. The overall rate of revision in our database of 979 primary THAs was 1.02%. Six additional patients who had received injections underwent investigation for infection because of persistent problems in the hip as compared with one in the control group.

Effect of intra-articular steroids on deep infections following total knee arthroplasty

“…A recent study had suggested increased incidence of infectious complications following total hip replacement in those patients who received intra-articular steroid injections [6]. In our study we found no such correlation between intra-articular steroid injection and deep infection following total knee arthroplasty.…”

“…Recently there have been concerns regarding the safety of intra-articular steroid injections. A recent study has suggested an increased incidence of infections in patients who received intra-articular hip injections prior to total hip arthroplasty [6]. There are no published studies correlating infections following total knee arthroplasties with previous intra-articular steroid injections.…”

Is the Infection Rate in Primary THA Increased After Steroid Injection?

“…The hospital records were available for all 350 patients (175 from the injected group and 175 from the control group). A power analysis using the conventional 80% power, based on a general PJI rate of 1% and using the 10% PJI rate in patients receiving a steroid injection before THA reported by Kaspar and de V de Beer [21], showed 122 patients per group would be required to obtain a result that is significant at a p value less than 0.05.…”

“…The data regarding an association between an increased risk for a periprosthetic joint infection (PJI) of a THA after an intraarticular steroid injection are conflicting. Two reports [21,24] showed more PJIs in a group of patients who had an intraarticular steroid injection in the hip before they had a THA. In two other studies, there was no increase in PJIs in patients who had THAs after intraarticular injections of a steroid into the ipsilateral hip [7,40].…”

Ultrasound Guided Hip Injection Techniques

“…In the literature, there are only two case reports mentioning septic hip involvement following intraarticular corticosteroid injection (Kruse DW, 2008) and four cases of hip aseptic osteonecrosis, but in three of them, corticosteroid deposition was made in another joint. (Kruse DW, 2008;Migliore A et al, 2010) Significant increase in arthroplasty revision secondary to infection in patients who received intraarticular corticosteroid injection prior to surgery is reported in a study performed in 2005 (Kaspar S & de V de Beer j, 2005), but other studies did not confirm any relationship between intraarticular corticosteroid injection prior to total hip arthroplasty. (Chitre AR et al, 2007) As caution, a gap of two months prior to the surgical event is recommended.…”