Intraarticular Steroids Before Joint Surgery Increase Infection Risk Save

Hip and knee intraarticular injection of corticosteroids are frequently prescribed to alleviate pain or inflammation in patients with osteoarthritis and rheumatoid arthritis, especially in the period leading up to scheduled arthroplasty.

The safety of preoperative hip injections was discussed at a presentation at the recent 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Using data from 177,762 patients in the Statewide Ambulatory Surgery and Inpatient Database, for Florida and California between 2005 to 2012, investigators showed that preoperative injections within three months of THR increased the overall risk of post-operative infection by 40%. The infection rate after one year was 2.06 percent in patients who did not receive an injection, but that rate increased to 2.81 percent in patients who had an injection within three months prior to their procedures. Injections appeared safe if done before this three months window.

A second study at the AAOS meeting identified 83,684 patients in the Humana, Inc. database who underwent TKR between 2007 and 2014.

When comparing those with an injection at least one year prior to TKR (29,603) versus those who did not (54,081), they found that rates of surgical site infection were significantly higher in patients with an injection prior to TKR than those without (4.4 percent versus 3.6 percent).

The rate of infection requiring a return to the operating room remained significantly higher for the patients receiving injections in the months prior to surgery, with an odds ratio (OR) of 1.8 for an injection within one month of surgery, and an OR of 1.4 for an injection seven months prior to TKR.

These data underscore the need for discussion with the patient and orthopedic surgery about pre-surgical pain management options.