CORR Insights®: Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

Total joint arthroplasty of the hip and knee is successful in most patients who undergo it, in that it generally relieves pain and increases their function for many years. But joint infections after arthroplasty are devastating, often resulting in additional surgery, increased cost, and persistent pain and loss of function.

For that reason, any steps we can take to decrease the risk of postoperative infection would be important to consider. Because so many patients who undergo arthroplasty first try a joint injection or two [⁵]—whether with corticosteroids or hyaluronic acid products—ascertaining whether having these shots increases a patient’s risk of periprosthetic joint infection after arthroplasty is a productive avenue of inquiry. Previous studies have disagreed on this point, with some suggesting joint injections in the month before arthroplasty increase the risk of postoperative infections [^{3, 6}] and others reporting no increased risk [^{2, 3}]. Thus, a meta-analysis on this point is an important next step.

In this month’s Clinical Orthopaedics and Related Research®, an author group from Guangzhou, China, provides us with a quality meta-analysis on this topic [⁴]. Looking in aggregate at studies on patients who had intra-articular injections within 1 year of arthroplasty, they found no increased risk of postoperative infection. However, the odds of a patient developing periprosthetic joint infection increased by about 30% (albeit with a somewhat wide CI, from 1.02-1.68) if the shot was administered within 3 months of hip or knee arthroplasty. Patients who had injections more than 3 months before surgery did not appear to be at an increased risk.

Based on these discoveries, the authors of this meta-analysis [⁴] recommend against performing intra-articular injections within 3 months of arthroplasty. I agree with that recommendation.