Safety of intra-articular steroid injections prior to arthroplasty: Best evidence selection and risk of bias considerations.

Abstract

Several systematic reviews have been performed to investigate whether intra-articular steroid injections can increase the risk of infection in subsequent arthroplasty. However, the conclusions of these systematic reviews are discordant. The purpose of the present study was to select best evidence and consider risk of bias of these systematic reviews and to provide recommendations through the best evidence. The systematic reviews that compared the infection rates of arthroplasty with or without previous intra-articular steroid injection were identified. The methodological quality and risk of bias of included systematic reviews were assessed by the AMSTAR instrument and ROBIS tool, respectively. Heterogeneity information within each variable was extracted from the included studies. The Jadad algorithm was then used to determine which systematic reviews can provide the best evidence. Six systematic reviews were eligible for inclusion. The Jadad decision-making tool suggested that two reviews with highest AMSTAR score should be selected. According to the ROBIS tool, there were three systematic reviews with low risk of bias and three with high risk of bias. As a result, two systematic reviews conducted by Charalambous etal. and Marsland etal. with highest AMSTAR scores and low risk of bias were selected as the best evidence. The present study demonstrates that intra-articular steroid injections prior to arthroplasty did not increase infection rates severely after the operation. However, the strength of recommendation is weak due to the limitations of current evidence. Further high-quality primary studies are still required.