Do Intra-articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review.

Samuel J Chmell,Elan Volchenko,Garrett R Schwarzman,Matthew A Siegel,Michael J Patetta,David T Rhode,Mark H Gonzalez

doi:10.1055/s-0041-1731327

Samuel J Chmell, Elan Volchenko + Show 5 more

Open Access

https://doi.org/10.1055/s-0041-1731327

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Abstract

There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, specifically periprosthetic joint infection (PJI). Thus, this retrospective review of all TKAs performed at a large, urban hospital will add valuable evidence to help guide future patient care. After exclusion criteria, we retrospectively reviewed 417 patients who received a TKA from a group of fellowship-trained orthopaedic surgeons between 2009 and 2016 at a single academic medical center. Minimum follow-up time was 1 year. Patients were separated into two groups: those who received a preoperative intra-articular corticosteroid injection and those who did not receive an injection. Subgroups were created based on the timing of their most recent preoperative injection: 0 to 3 months, 3 to 6 months, 6 to 12 months, 12+ months, and an unknown time period. Postoperative outcomes for PJI, revision TKA, and manipulation under anesthesia (MUA) were analyzed via a Chi-square test. No statistically significant postoperative differences were observed between groups: PJI (p = 0.904), revision TKA (p = 0.206), and MUA (p = 0.163). The temporal subgroups also failed to demonstrate a statistically significant result: PJI (p = 0.348), revision TKA (p = 0.701), and MUA (p = 0.512). This study revealed no absolute or temporal association between preoperative, intra-articular corticosteroid injections, and complications after TKA. Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions.

Highlights

There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, periprosthetic joint infection (PJI)
Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions
220 patients received an intra-articular corticosteroid injection prior to TKA, while the control group consisted of 197 patients who did not receive intra-articular injections prior to surgery

Summary

Introduction

There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, periprosthetic joint infection (PJI). Physicians are encouraged to use less invasive methods to alleviate the pain associated with osteoarthritis. The American Academy of Orthopedic Surgeons, in their updated clinical guidelines for the management of osteoarthritis, lowered their recommendations for the use of intraarticular corticosteroid injections. They no longer offer any recommendation for or against them, citing insufficient evidence[6]. There is speculation that intra-articular corticosteroid injections before total knee arthroplasty (TKA) lead to higher rates of periprosthetic joint infection (PJI). There are no clear recommendations regarding the timing of these injections with respect to surgery

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