Abstract:BackgroundIntraarticular steroid injection has been widely used by orthopaedic surgeons as an alternative to surgery and as a diagnostic tool. An association between infection after total hip arthroplasty and intraarticular steroid injection has been reported, particularly when the injections occur within 6 weeks of the operation. Given that recent recommendations by the Osteoarthritis Research Society International continue to endorse the use of intraarticular steroid injection, this study was used to further… Show more
“…Finally, after reading the full text of these articles, we excluded 13 that did not meet the inclusion criteria. Ultimately, 11 studies with a total of 173,465 hip or knee arthroplasties were included in our meta-analysis [9,13,14,16,25,26,32,34,35,37,43] (Fig. 1).…”
Section: Search Resultsmentioning
confidence: 99%
“…Third, as all the studies included were retrospectively designed, confounding factors, such as injection procedure, patient characteristics, surgical experience, operating room conditions, and the time of follow-up, could not be well controlled for in our analysis; particularly concerning in this regard was patients' comorbidities, such as hypertension and diabetes, which are known PJI risk factors [7,40]. However, in 9 of 11 studies, the control groups were matched by age and gender [9,13,14,16,25,26,34,35,43] (the other two studies did not [32,37]); we believe this at least partly should mitigate that concern. Nonetheless, readers should bear in mind that studies of this design generally suffer from the same kinds of biases-the most important ones being selection bias, transfer bias, and assessment bias-and if anything, those tend to make the results appear better than they are.…”
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.
“…Finally, after reading the full text of these articles, we excluded 13 that did not meet the inclusion criteria. Ultimately, 11 studies with a total of 173,465 hip or knee arthroplasties were included in our meta-analysis [9,13,14,16,25,26,32,34,35,37,43] (Fig. 1).…”
Section: Search Resultsmentioning
confidence: 99%
“…Third, as all the studies included were retrospectively designed, confounding factors, such as injection procedure, patient characteristics, surgical experience, operating room conditions, and the time of follow-up, could not be well controlled for in our analysis; particularly concerning in this regard was patients' comorbidities, such as hypertension and diabetes, which are known PJI risk factors [7,40]. However, in 9 of 11 studies, the control groups were matched by age and gender [9,13,14,16,25,26,34,35,43] (the other two studies did not [32,37]); we believe this at least partly should mitigate that concern. Nonetheless, readers should bear in mind that studies of this design generally suffer from the same kinds of biases-the most important ones being selection bias, transfer bias, and assessment bias-and if anything, those tend to make the results appear better than they are.…”
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.
“…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).…”
Objective: The current review was designed to assess the impact of prior intra-articular injections on the risk of prosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA) with a focus on the timing of injection before surgery.Methods: The databases of PubMed, Embase and Google Scholar were searched up to 15th June 2021. All studies comparing the incidence of PJI with and without prior intra-articular injections were included. Risk ratios (RR) with 95% confidence intervals were calculated for PJI.Results: Nineteen studies were included. Both corticosteroids and hyaluronic acid injections were used before TJA in the included studies. Overall, comparing 127,163 patients with prior intra-articular injections and 394,104 patients without any injections, we noted a statistically significant increased risk of PJI in the injection group (RR 1.24 95% CI: 1.11, 1.38 I2 = 48% p = 0.002). On subgroup analysis, there was a statistically significant increased risk of PJI in the injection group in studies where intra-articular injections were administered <12 months before surgery (RR 1.18 95% CI: 1.10, 1.27 I2 = 7% p < 0.00001). Furthermore, on meta-analysis, we noted non-significant but increased risk of PJI when injections were administered 1 month (RR 1.47 95% CI: 0.88, 2.46 I2 = 77% p = 0.14), 0–3 months (RR 1.22 95% CI: 0.96, 1.56 I2 = 84% p = 0.11), and 3–6 months (RR 1.16 95% CI: 0.99, 1.35 I2 = 49% p = 0.06) before surgery.Conclusion: Our results indicate that patients with prior intra-articular injections have a small but statistically significant increased risk of PJI after TJA. Considering that PJI is a catastrophic complication with huge financial burden, morbidity and mortality; the clinical significance of this small risk cannot be dismissed. The question of the timing of injections and the risk of PJI still remains and can have a significant impact on the decision making.Systematic Review Registration: PROSPERO: CRD42021258297.
“…A total of 1461 titles and abstracts were preliminarily reviewed, of which 8 studies [ 13 , 14 , 16 , 21 - 25 ] eventually satisfied the eligibility criteria (Figure 1 ). One of the eight studies [ 22 ] published in abstract form.…”
Section: Resultsmentioning
confidence: 99%
“…One of the eight studies [ 22 ] published in abstract form. Six studies [ 13 , 14 , 16 , 22 , 23 , 25 ] evaluated infection rates in total hip arthroplasties (THA) and two studies [ 21 , 24 ] in total knee arthroplasties (TKA). Figure 1 The study selection and inclusion process.…”
BackgroundIntraarticular steroid injections are widely used in joint arthritis. However, the data regarding an association between an increased risk for arthroplasty infection after an intraarticular steroid injection are still conflicting. We conducted a meta-analysis to evaluate the evidence from relevant studies that examine the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty and to develop GRADE based recommendations for using the steroid before arthroplasty.MethodsA systematic search of all studies published through August 2014 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The relevant studies that examined the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty were identified. Demographic characteristics, infection rates and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system.ResultsEight studies looking at hip and knee arthroplasties were included. Meta-analysis showed that patients with steroid injection before arthroplasty had a higher deep infection rate than patients without steroid injection (OR = 2.13, 95% CI 1.02-4.45), but no significant effect on superficial infection rate (OR = 1.75, 95% CI 0.74-4.16). The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations.ConclusionsIntraarticular steroid injections may lead to increased deep infection rates of subsequent joint arthroplasty but not the superficial infection rates. Due to the poor quality of the evidence currently available, further studies are still required.
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