Abstract
Recalcitrant pain after total knee replacement (TKR) is sometimes treated with intra-articular steroid injections (IASI), with few studies reporting on the risk of subsequent periprosthetic joint infection (PJI). This is a systematic review to evaluate the incidence and risk of PJI after IASI into a total knee replacement.We searched online databases using the keywords "total knee replacement," "total knee arthroplasty," "steroids" and "intra-articular injection." A total of 7386 articles (PubMed - 91, Embase - 70, Web of Science - 57, CINAHL - 8, and Google Scholar - 7160) were retrieved on the initial search. After applying exclusion criteria, four articles were included in this review for evaluation and statistical analysis. There were no level one or two studies.The incidence of infection after IASI at 12 months was 138/6499 or 2.1%, while the incidence of infection rate among controls at 12 months was 158/11256 or 1.4%. A chi-square test showed that the difference in infection rate was significant (p = 0.0002424). A caveat is that simple statistical test results are virtually guaranteed to be statistically significant with large sample size.IASI into a TKR is not a benign procedure and that may be associated with a significantly increased risk of subsequent periprosthetic joint infection. We, therefore, recommend against IASI into a TKR until better studies can be performed to determine their safety and efficacy.
Highlights
Recalcitrant pain after total knee replacement (TKR) is sometimes treated with intra-articular steroid injections (IASI), with few studies reporting on the risk of subsequent periprosthetic joint infection (PJI)
Periprosthetic joint infection (PJI) rate after IASI was the primary outcome evaluated in this review
There is a lack of reliable studies on the indications, utility, and incidence of PJI after IASI after TKR
Summary
Total knee replacement (TKR) is a commonly done procedure in end-stage osteoarthritis of the knee. It can improve the patient's symptoms and lifestyle significantly [1]. There is a proportion of patients who remain dissatisfied after surgery, secondary to pain or stiffness, varying from 1354% [2,3,4,5,6]. The etiology of chronic pain after TKR is multifactorial. It can limit patients' functional capacity and demands a thorough workup. There remains a subset of patients who, despite extensive workup, do not have an apparent cause of pain after TKR, and they remain unhappy after the procedure [11,12,13]
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