Risk of Periprosthetic Infection Following Intra-Articular Corticosteroid Injections After Total Knee Arthroplasty

Roecker, Zoe; Quinlan, Nicole D.; Browne, James A.; Werner, Brian C.

doi:10.1016/j.arth.2019.11.017

Cited by 22 publications

(22 citation statements)

References 27 publications

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“… 21 Intra-articular injections are another alternative, with some evidence for short-term pain relief from corticosteroid injection, 22 hyaluronic acid, 23 protein-rich plasma 24 and saline. 25 There are, however, concerns about the potential risks for side effects with these treatments, including deterioration in arthritis severity, 26 and postoperative infection, 27 that limit their use perioperatively.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study

et al. 2021

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BackgroundCOVID-19 has had a detrimental impact on access to hip and knee arthroplasty surgery. We set out to examine whether this had a subsequent impact on preoperative opioid prescribing rates for those awaiting surgery.MethodsData regarding patient demographics and opioid utilisation were collected from the electronic health records of included patients at a large university teaching hospital. Patients on the outpatient waiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) were compared with historical controls (Controls) who had previously undergone surgery. A sample size calculation indicated 452 patients were required to detect a 15% difference in opioid prescription rates between groups.ResultsA total of 548 patients (58.2% female) were included, 260 in the COVID-19 group and 288 in the Controls. Baseline demographics were similar between the groups. For those with data available, the proportion of patients on any opioid at follow-up in the COVID-19 group was significantly higher: 55.0% (143/260) compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% (11/260) vs 4.8% (13/272)) for COVID-19 and Controls, respectively. The median waiting time from referral to follow-up was significantly longer in the COVID-19 group compared with the Controls (455 days vs 365 days; p<0.0001).ConclusionThe work provides evidence of potential for an emerging opioid problem associated with the influence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia for those with end-stage arthritis should be explored, and prolonged waiting times for surgery ought to be avoided in the recovery from COVID-19 to prevent more widespread opioid use.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study

et al. 2021

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“…8,9 In addition, several studies have suggested that a corticosteroid injection too close to the date of total knee arthroplasty significantly increases the risk of periprosthetic joint infection and surgical-site infection. 10,11 Furthermore, previous investigations have identified male sex, diabetes, obesity, and tobacco use, among other factors, to be independent risk factors for surgical-site infection after an arthroscopic knee surgical procedure. 12 However, the effect of preoperative corticosteroid injections on postoperative infection risk after meniscectomy remains unclear.…”

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confidence: 99%

Corticosteroid Injections 1 Month Before Arthroscopic Meniscectomy Increase the Risk of Surgical-Site Infection

Forsythe

Agarwalla

Cohn

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…At 1 year, steroid patients had a 2.4% risk for infection vs. 1.4% for those who did not receive a steroid injection. Similarly, this was statistically significant ( P < 0.0001) 29 …”

Section: Interventional Treatments For Painful Tkamentioning

confidence: 53%

Beyond Revision Surgery: Work‐Up and Interventional Treatments for the Painful Total Knee Arthroplasty

et al. 2020

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Total knee arthroplasty is a common and successful treatment modality for knee arthritis that is refractory to conservative management strategies. Over 600,000 arthroplasties are performed per year in the United States, and this number is expected to increase in the coming years. Unfortunately, 8% to 34% of patients experience chronic pain after having a total knee arthroplasty. These patients should undergo an appropriate work-up by the orthopedic surgeon, but many times a surgical problem is not uncovered. In these situations, a thorough and specific plan for pain management should be sought. In this article, we outline the work-up of a painful total knee arthroplasty. Then we provide a thorough review of interventional pain management strategies and highlight the pertinent literature. Lastly, we hypothesize future developments in the field that may provide better outcomes for patients suffering from painful total knee arthroplasty. &

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Risk of Periprosthetic Infection Following Intra-Articular Corticosteroid Injections After Total Knee Arthroplasty

Cited by 22 publications

References 27 publications

Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study

Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study

Corticosteroid Injections 1 Month Before Arthroscopic Meniscectomy Increase the Risk of Surgical-Site Infection

Beyond Revision Surgery: Work‐Up and Interventional Treatments for the Painful Total Knee Arthroplasty

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