Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

Abstract

Background Intra-articular injections containing a corticosteroid are used frequently, and periprosthetic joint infection is a serious complication after total joint arthroplasty. There is debate regarding whether intraarticular corticosteroid injections before arthroplasty increase periprosthetic joint infection after surgery. Questions/purposes (1) Does a previous intra-articular corticosteroid injection increase the odds of infection after subsequent hip or knee arthroplasty? (2) Does this risk vary based on how soon before the arthroplasty (such as less than 3 months before surgery) the injection is administered?Methods Using the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to July 2021, we searched for comparative studies in English on patients who received intra-articular corticosteroid injections before arthroplasty and that tracked the frequency of infection after arthroplasty. We extracted data on the risk of infection after subsequent joint arthroplasty. The keywords included "corticosteroid," "steroid," "arthroplasty," "knee replacement," and "hip replacement." Eleven retrospective, comparative studies from four countries were included, of which 10 reported the specific diagnosis criteria and oneThe institution of one or more of the authors (QZ) has received, during the study period, funding from the Natural Science Foundation of Guangdong (2015A030313353). The institution of one or more of the authors (CZ) has received, during the study period, funding from the Research Project of Innovating to Strengthen the First Hospital of Guangzhou University of Chinese Medicine (2019IIT06). Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

The safety of intraarticular injection prior to total hip arthroplasty: a review

“…Despite that, the two metaanalyses concluded that there was an increased risk of infection in patients who had received prior IAIs. 38,39 One potential factor leading to the variance and difference in these conclusions is the larger patient population size in some of the more recent publications. It is also notable that these two metaanalyses combined data from THA and TKA studies to interpret the effect of preoperative IAIs on joint arthroplasty as a whole, not specific to the hip or knee.…”

CORR Insights®: Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

“…I'm concerned that the answer to one or both of those questions may be "yes." In the current study [4], the first question was explored, but the spread of the 95% CI made me wonder whether more data will change the authors' no-difference conclusion. The second of those questions remains, as far as I know, unanswered.…”

Letter to the Editor: Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

“…The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or The Association of Bone and Joint Surgeons ® . in a robust way, we believe it should have been included in the meta-analysis of Lai et al [5]. Chitre et al [1] included 36 patients as an injection group, and although the small sample size is insufficient to state that ipsilateral steroid injection does not increase the risk of postoperative complications in THA, we believe that it should still be included in this meta-analysis.…”

“…If the inclusion criteria for this article included studies of corticosteroid intra-articular injection in combination with other medication types, the authors missed four trials eligible for inclusion in their review. One retrospective study of 40 patients who received an intra-articular steroid injection prior to TKA found no infections [9]; of course, a study of this size is too small to make claims of safety with respect to an endpoint as uncommon as infection, and those authors probably should not have done so, we believe this study should have been included in the meta-analysis in CORR ® [5]. Their injection regimen was a mixture of depo methylprednisolone and bupivacaine.…”