The Timing of Hip Arthroscopy After Intra-articular Hip Injection Affects Postoperative Infection Risk

Abstract

To evaluate the association of preoperative intra-articular hip injection with surgical site infection after hip arthroscopy. A large administrative database was used to identify all patients undergoing hip arthroscopy from 2007 to 2015 within a single private insurer and from 2005 to 2012 within Medicare in the United States. Those that received an ipsilateral preoperative intra-articular hip injection were identified. The patients were then divided into the following groups based on the interval between preoperative injection and ipsilateral hip arthroscopy: (1) <3months, (2) 3 to 6months, and (3) 6 to 12months. These groups were compared to a control group composed of patients with no history or a remote history (>12months) of preoperative hip injection. Patients developing a surgical site infection within 6months following hip arthroscopy were identified using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes associated with infection. Groups were compared using a multivariate logistic regression analysis to control for age, gender, body mass index, smoking status, alcohol usage, and multiple medical comorbidities including diabetes mellitus, hemodialysis use, inflammatory arthritis, and peripheral vascular disease. In total, 19% of privately insured and 6% of Medicare patients received a hip injection within 12months of hip arthroscopy. The overall infection rate in privately insured and Medicare patients was 1.19% and 1.10%, respectively. Preoperative hip injection within 3months of surgery was associated with a significantly higher risk of postoperative infection versus controls (2.16%, odds ratio [OR] 6.1, P < .001, for privately insured group; 2.80%, OR 1.99, P= .037, for Medicare group). In contrast, preoperative hip injection given after more than 3months of surgery was not associated with an increased risk of postoperative infection versus controls. Risk of infection afterhip arthroscopy increased when preoperative intra-articular hip injections were given within 3months of surgery. Level III, retrospective comparative study.