Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis

Kim, Young Mo; Joo, Yong Bum; Song, Ju-Ho

doi:10.1186/s13018-023-03637-4

Cited by 9 publications

(4 citation statements)

References 41 publications

(82 reference statements)

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“…Additionally, while there has been concern regarding potential risk for osteoarthritis progression, avascular necrosis, and articular collapse following intra-articular steroid injections, a recent study did not demonstrate this association after controlling for baseline osteoarthritis severity and pre-existing avascular necrosis/subchondral insufficiency fracture [ 40 ]. However, caution is advised and patient-specific risks should be considered in patients at greater risk of adverse outcomes, such as those who have diabetes mellitus and therefore can experience higher post-injection glycemic levels [ 41 ], as well as those already on systemic steroids [ 38 ], and those who are anticipating arthroplasty within 3 months, as this increases the risk of periprosthetic joint infection [ 42 ]. Furthermore, intra-articular injections should be avoided entirely in patients who have clinical evidence of skin or soft tissue infection overlying the target joint.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia

Song

Kirsch

Jarjour

2023

JPM

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Background: Systemic lupus erythematosus (SLE) is a complex autoimmune condition with varied clinical presentations, and musculoskeletal pain is one of the most commonly associated symptoms. However, fibromyalgia (FM) is a prevalent co-existing condition in SLE patients that can also cause widespread pain, and in patients with both conditions, it is often difficult to distinguish the underlying cause of musculoskeletal pain and provide optimal therapy. Methods: A retrospective cohort study was conducted including all adult SLE patients who received musculoskeletal ultrasound (US) examinations for joint pain at the Ohio State University Wexner Medical Center between 1 July 2012, and 30 June 2022. Binary and multiple logistic regression analyses were performed to determine predictors of US-detected inflammatory arthritis as well as improved musculoskeletal pain. Results: A total of 31 of 72 SLE patients (43.1%) had a co-existing diagnosis of FM. In binary logistic regression, a co-existing diagnosis of FM was not significantly associated with US-detected inflammatory arthritis. In multiple logistic regression analysis, clinically detected synovitis was significantly associated with US-detected inflammatory arthritis (aOR, 142.35, p < 0.01), and there was also a weak association with erythrocyte sedimentation rate (ESR) (aOR 1.04, p = 0.05). In separate multiple logistic regression analysis, US-guided intra-articular steroid injection was the only predictor of improved joint pain at follow-up visit (aOR 18.43, p < 0.001). Conclusions: Musculoskeletal US can be an effective modality to detect inflammatory arthritis as well as to guide targeted intra-articular steroid injection to alleviate joint pain in SLE patients with or without FM.

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Section: Discussionmentioning

confidence: 99%

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia

Song

Kirsch

Jarjour

2023

JPM

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“…Similarly, Albanese et al’s meta-analysis found a significant correlation between THA and PJI after corticosteroid injections, indicating a 20% increased risk for patients receiving intra-articular corticosteroids within three months before TJA [ 25 ]. However, other studies reported no discernible rise in the PJI rate due to prior intra-articular corticosteroid injections [ 76 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Preoperative Risk Factors for Periprosthetic Joint Infection: A Narrative Review of the Literature

Lucenti,

Testa,

Caldaci

et al. 2024

Healthcare

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Periprosthetic joint infection (PJI) poses a challenging complication for many patients undergoing arthroplasty, and the literature identifies numerous risk factors. A comprehensive understanding of the primary risk and protective factors for PJI is valuable for surgeons. This article aims to compile and summarize the key risk factors for PJI documented in the literature. Some risk factors are related to the nutritional status of patients, with obesity, weight loss, hypovitaminosis, and malnutrition being frequently reported. Pathologies affecting patients also contribute to PJI risk, including septic arthritis, hepatitis, diabetes, urinary tract infections, anemia, hypothyroidism, osteoporosis, and dental pathologies. Unhealthy habits, such as tobacco and drug abuse, are significant factors. Previous corticosteroid injections may also play a role in infection development. A few protective factors are also reported in the literature (use of statins, preoperative decolonization, and preadmission skin preparation). The identification of risk factors and the implementation of evidence-based preoperative protocols are essential steps in reducing the incidence of PJI.

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“…Despite their widespread use for diagnostic and therapeutic purposes, recent studies have reported an increased risk of infection when intra-articular injections are administered too close to elective surgeries, such as hip arthroscopy, generally within three months prior [ 4 - 8 ]. For example, a recent meta-analysis involving over 300,000 patients found that administering preoperative intra-articular steroid injections within three months of total knee arthroplasty (TKA) significantly increased the odds of periprosthetic joint infection (PJI) (P < 0.01) [ 9 ]. Similarly, another study indicated a significantly higher risk of PJI when intra-articular injections were given within three months prior to total shoulder arthroplasty (TSA), with elevated odds of infection at both three (P = 0.007) and six months (P = 0.001) postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Infection Following Hip Arthroscopy in Patients Receiving Preoperative Intra-articular Injections: A Systematic Review and Meta-Analysis

Aamer,

Tokhi,

Asim

et al. 2024

Cureus

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Intra-articular injections prior to hip arthroscopy are often used to diagnose and conservatively manage hip pathologies, such as femoroacetabular impingement, labral tears, and chondral lesions. As a diagnostic tool, the relief of hip pain following an intra-articular injection helps pinpoint the primary source of pain and assists surgeons in recommending arthroscopic intervention for underlying intra-articular pathologies. However, when injections are not sufficiently spaced apart in time prior to hip arthroscopy, there is an elevated risk of postoperative infection. This systematic review aims to assess whether preoperative intra-articular injections prior to hip arthroscopy are associated with an increased risk of postoperative infection and to determine the safety timeframe for administering such injections prior to the procedure. A comprehensive search was conducted in the PubMed, Embase, and Cochrane Library databases to identify studies examining the relationship between preoperative intra-articular injections and postoperative infection following hip arthroscopy. A meta-analysis was conducted to compare the risk of infection between patients who received injections prior to hip arthroscopy at varying intervals and those who did not receive any preoperative injections. Five studies were included (four level III and one level IV), which consisted of 58,576 patients (58.4% female). Injections administered anytime prior to hip arthroscopy posed a significantly higher risk of infection compared to no history of prior injections (risk ratio: 1.45, 95% confidence interval: 1.14-1.85, P = 0.003). However, upon subanalysis, the risk of infection was significantly higher among patients who received injections within three months prior to hip arthroscopy compared to those who did not receive injections (risk ratio: 1.55, 95% confidence interval: 1.19-2.01, P = 0.001). Additionally, no significant difference in infection risk was observed when injections were administered more than three months before hip arthroscopy compared to no injections (risk ratio: 1.05, 95% confidence interval: 0.56-1.99, P = 0.87). The findings suggest that patients undergoing hip arthroscopy who have previously received intra-articular injections may face a statistically higher risk of postoperative infection, particularly when the injection is administered within three months prior to hip arthroscopy. Consequently, surgeons should exercise caution and avoid administering intra-articular injections to patients scheduled for hip arthroscopy within the subsequent three months to mitigate the increased risk of infection.

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Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis

Cited by 9 publications

References 41 publications

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia

The Utility of Ultrasound in Evaluating Joint Pain in Systemic Lupus Erythematosus: Looking beyond Fibromyalgia

Preoperative Risk Factors for Periprosthetic Joint Infection: A Narrative Review of the Literature

Postoperative Infection Following Hip Arthroscopy in Patients Receiving Preoperative Intra-articular Injections: A Systematic Review and Meta-Analysis

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