Intra-Articular Knee Injections Before Total Knee Arthroplasty: Outcomes and Complication Rates

Kokubun, Brent A.; Manista, Gregory C.; Courtney, P. Maxwell; Kearns, Seán; Levine, Brett R.

doi:10.1016/j.arth.2017.01.041

Cited by 24 publications

(21 citation statements)

References 21 publications

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“…Some of the variables that have been shown to affect the outcome after total joint replacement include social and demographic characteristics, medical comorbidities, and surgical technique [3][4][5][6][7]. Areas of continued active research include the effect of intrinsic factors such as obesity [8][9][10], cardiovascular disease [11,12], mental health disorders [13•, 14-17•, 18•, 19], hepatic disease [20, 21•, 22, 23•, 24], nutritional deficiencies [25-29•, 30], bone metabolic disease [31][32][33][34][35][36][37], and diabetes mellitus [38•, 39, 40], as well as external factors such as nicotine use [41,42], recent corticosteroid injections [43][44][45][46][47], and discharge disposition [48,49]. The goal of this article is to review the most recent literature, published within the last 3 years, regarding a selection of patient-specific factors that may influence This article is part of the Topical Collection on Quality and Cost Control in TJA outcomes following total joint arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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Purpose of Review It is well established that certain patientspecific risk factors affect outcomes following total joint arthroplasty. The goal of this paper is to summarize the latest data on several variables that have been investigated in the last 3 years and to characterize the effects these factors have on the success of hip and knee replacement. Recent Findings Preoperative diagnoses of depression and anxiety, liver disease, hypoalbuminemia, vitamin D deficiency, and diabetes mellitus are associated with increased risk of postoperative complications and can lead to worse outcomes after joint replacement surgery. Summary Recent investigations have clearly established a link between these patient-specific factors and poor outcomes after hip and knee arthroplasty, but future research is needed to determine best practices for stratifying and mitigating these risks for patients.

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Section: Introductionmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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“…Works by Amin et al found no signi cant difference in the infection rates of 783 patients who received an injection and 845 who did not [16]. In a similar manner, Kokubun et al found no signi cant difference in complication rates, infection rates, and short-term functional outcomes of 175 patients who received four or more preoperative injections and 267 who received three or less [17].In short, these single-center retrospective chart review studies contained similar patient numbers to our study and also observed no signi cant association between preoperative intra-articular corticosteroid injections and an increased postoperative infection rate.…”

Section: Resultsmentioning

confidence: 90%

“…However, due to the underpowered and heterogeneous nature of many prior studies, both of these publications cited the need for increased larger-sized studies on the matter [14,15]. Since that time, additional studies seem to display dichotomy between relatively smaller, single center studies [16,17], such as this one, and larger database studies [9,11].…”

Section: Resultsmentioning

confidence: 99%

“…However, the available literature on this topic demonstrates con icting evidence. Several studies have reported that preoperative, intra-articular corticosteroid injections lead to an increased rate of PJI [8][9][10][11],while other studies have reported no difference in surgical outcomes [12][13][14][15][16][17]. Currently, there are no clear recommendations regarding the timing of these injections with respect to surgery.…”

Section: Introductionmentioning

confidence: 99%

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Do Intra-Articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review

Rhode

Siegel

Volchenko

et al. 2020

Preprint

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Background:There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, specifically periprosthetic joint infection (PJI). Thus, this systematic review of all TKAs performed at a large, urban hospital will add valuable evidence to help guide future patient care.Methods: After exclusion criteria, we retrospectively reviewed 417 patients who received a TKA from a group of fellowship-trained orthopaedic surgeons between 2009 to 2016 at a singleacademic medical center. Minimum follow-up time was oneyear. Patients were separated into two groups: those who received a preoperative intra-articular corticosteroid injection and those who did not receive an injection. Subgroups were created based on the timing of their most recent preoperative injection: 0-3 months, 3-6 months, 6-12 months, 12+ months, and an unknown time period. Postoperative outcomes for PJI, revision TKA, and manipulation under anesthesia (MUA)were analyzed via a chi-square test.Results: No statistically significant postoperative differences were observed between groups: PJI (p-value = 0.904), revision TKA (p-value= 0.206), and MUA (p-value= 0.163). The temporal subgroups also failed to demonstrate a statistically significant result: PJI (p-value= 0.348), revision TKA (p-value= 0.701), and MUA (p-value= 0.512).Conclusions: This study revealed no absolute or temporal association between preoperative, intra-articular corticosteroid injections and complications after TKA. Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions.

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“…Intra-articular injections can be performed to inject a corticosteroid into a joint for the treatment of a non-infectious inflammatory process or for the injection of a viscosupplement [ 13 , 14 ]. While septic arthritis has been reported to occur in less than 1 out of 2700 cases following intra-articular injection, it is unclear if low-grade joint infections occur more frequently [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study

Xu¹,

Peng²,

Chai³

et al. 2017

Med Sci Monit

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BackgroundThe aim of this study was to investigate whether needles introduce skin plugs into joints during arthrocentesis.Material/MethodsIn the first part of this study, the arthrocentesis site was scrubbed with a fluorescein sodium swab, and 90 needles were inserted through the joint tissue and collected for examination under a fluorescence microscope. In the second part of this study, the joints were injected using 720 needles of different gauges. Two different randomly assigned needle insertion techniques were used: needle insertion straight through the joint capsule (subgroup 1) or insertion of the needle into the subcutaneous tissue followed by flushing of the needle with 0.5 mL of 0.9% normal saline prior to advancing the needle through the joint capsule (subgroup 2).ResultsOf the 90 needle tips examined in the first part of this study, 21 had high-grade fluorescein contamination. In the second part of this study, the incidence of tissue, epidermis, and dermis contamination in subgroup 1 was 57.2%, 43.1%, and 25.0%, respectively. There was no significant difference in the incidence among different gauge needles, except for a difference in epidermis contamination between the 21-gauge and 23-gauge needles. Compared to subgroup 1, subgroup 2 had a significantly lower OR for tissue contamination.ConclusionsIt is common to introduce tissue coring with epidermis and dermis into the joint during arthrocentesis, which poses a potential risk for septic arthritis. However, tissue contamination of the joint may be reduced by flushing saline through the needle into the subcutaneous tissues prior to entering the joint capsule.

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Intra-Articular Knee Injections Before Total Knee Arthroplasty: Outcomes and Complication Rates

Cited by 24 publications

References 21 publications

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Do Intra-Articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review

Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study

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