Intraarticular Hip Injection and Early Revision Surgery Following Total Hip Arthroplasty: A Retrospective Cohort Study

Abstract

Objective. Therapeutic intraarticular injections are used in the management of hip osteoarthritis (OA).Some studies suggest that their use increases the risk of infection and subsequent revision surgery after primary total hip arthroplasty (THA), while others do not. We undertook this study to clarify the relationship between prior intraarticular injection and the risk of complication in a subsequent primary THA.Methods. In a cohort of patients with hip OA who underwent a primary elective THA between 2002 and 2009, we identified those who received >1 intraarticular injection performed by a radiologist in the 5 years preceding their THA. Multivariable Cox proportional hazards models were used to determine the relationship between receipt of a presurgical injection (no injection, 1-5 years prior to THA, or <1 year prior to THA) and the occurrence of postsurgical joint infection and revision THA in the following 2 years, while controlling for confounders.Results. Of 37,881 eligible THA recipients, 2,468 (6.5%) received an intraarticular injection performed by a radiologist within 5 years of their THA (1,691 at <1 year, 777 at 1-5 years). Controlling for age, sex, comorbidity, frailty, income, and provider volume, those who had an injection in the year preceding surgery were at increased risk of infection (adjusted hazard ratio [HR] 1.37, P ‫؍‬ 0.03) and revision THA (adjusted HR 1.53, P ‫؍‬ 0.03) within 2 years of the primary THA, relative to patients who did not. The association between prior injection and revision arthroplasty was attenuated and became nonsignificant (adjusted HR 1.41, P ‫؍‬ 0.13) after occurrence of postoperative infection was controlled for in the regression model. No effect was found for injection 1-5 years prior to surgery.Conclusion. Intraarticular injection in the year preceding THA independently predicted increased risk of infection leading to early revision surgery. Further studies are warranted to elucidate explanations for these findings.

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

“…While matched cohorts were used in a few studies, multivariableadjusted data were not reported by majority studies, prohibiting a pooled analysis. In the few studies reporting multivariableadjusted results, some demonstrated no increased risk of PJI (19,31) while others demonstrated an increased risk (21,34).…”

“…Seven studies were excluded with reasons. Finally, 19 studies were included in this systematic review and meta-analysis (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

Intra-Articular Hyaluronic Acid Injections Less Than 6 Months Before Total Hip Arthroplasty: Is It Safe? A Retrospective Cohort Study in 565 Patients

“…Patients who had an injection within 1 year of THA showed higher PJI rates than patients who did not receive prior intra-articular injection (3.3% vs 2.4%, P ¼ .04). Also, controlling for confounders, an elevated hazard ratio of 1.37 of PJI was found after prior injection [25]. Additionally, McIntosh et al found no difference in infection rate in a matched cohort of 448 (224 per group) THAs.…”

“…Of the 2 studies reporting increased infection rates, Kaspar et al [8] showed PJI rates of 10% (4/40 patients) in their CS group, compared to 0% in the control group (0/40 patients), but their study lacked statistical power. Second, Ravi et al [25] included 37,881 THA patients in their database study, of whom 2468 received an intra-articular injection within 5 years prior to THA (69% <1 year). Patients who had an injection within 1 year of THA showed higher PJI rates than patients who did not receive prior intra-articular injection (3.3% vs 2.4%, P ¼ .04).…”

Editorial Commentary: Intra-articular Injection for Osteoarthritis—Is It Hip or Not?

“…Cortisone administered in and around the joint prior to arthroplasty may also subject the patient to a slightly elevated risk of deep prosthetic infection. 10,11 This risk is considered so significant that the American Academy of Orthopaedic Surgeons categorizes IA cortisone injection as a time-dependent risk factor for prosthetic joint infection. 12 Although controversy remains, most surgeons have settled on waiting a minimum of 3 months after corticosteroid injection before prosthetic implantation.…”