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How do pre-operative intra-articular injections impact periprosthetic joint infection risk following primary total hip arthroplasty? A systematic review and meta-analysis

  • Hip Arthroplasty
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Although intra-articular injections (IAIs) serve as the first-line non-surgical management for severe osteoarthritis (OA), recent analyses have suggested they are associated with an increased infection risk following primary total hip arthroplasty (THA). Therefore, our systematic review and meta-analysis explored the relationship between IAIs and periprosthetic joint infection (PJI) following THA reported in the current literature.

Methods

Five online databases were queried for analyses published from January 1st, 2000–May 1st, 2021 reporting on PJI rates between patients undergoing primary THA who did and did not preoperatively receive an IAI. The overall pooled effect of injection status on PJI incidence was determined using Mantel–Haenszel (M-H) models. This was similarly conducted for segregated preoperative intervals: 0–3 months, > 3–6 months, > 6 + months.

Results

A total of 11 articles were included in our analysis reporting on 278,782 THAs (IAI: n = 41,138; no IAI: n = 237,644). Patients receiving pre-operative injections had a significantly higher risk of PJI (OR: 1.31, 95% CI 1.07–1.62; p = 0.009). However, this finding was not robust. IAI receipt within 3-months of THA was associated with significantly higher PJI rates (OR: 1.68, 95% CI 1.48–1.90; p < 0.001). However, no significant difference was demonstrated in the > 3–6 month (OR: 1.19, 95% CI 0.94–1.52; p = 0.16) and > 6 + month sub-analyses (OR: 1.20, 95% CI 0.96–1.50; p = 0.11). The results of all sub-analyses remained were robust.

Discussion

Our findings suggest that patients requiring THA should wait at least 3-months following IAI to reduce post-operative infection risk. This information can help inform patients considering OA management options, as well as adult reconstruction surgeons during preoperative optimization.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA

    Amanda Avila, Michael T. Do, Alexander J. Acuña, Linsen T. Samuel & Atul F. Kamath

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  1. Amanda Avila
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  2. Michael T. Do
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  3. Alexander J. Acuña
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Correspondence to Atul F. Kamath.

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Conflict of interest

A.F.K. reports the following disclosures: research support (Signature Orthopaedics), paid presenter or speaker (DePuy Synthes and Zimmer Biomet), paid consultant (DePuy Synthes and Zimmer Biomet), stock or stock options (Zimmer Biomet, Johnson & Johnson, and Procter & Gamble), IP royalties (Innomed), and board or committee member (AAOS, AAHKS, and Anterior Hip Foundation). J.E.O. reports the following disclosures: board or committee member (AAHKS), paid consultant (Depuy), and research support (DePuy). A.J.A., L.T.S., M.T.D., and A.A. have nothing to disclose.

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Avila, A., Do, M.T., Acuña, A.J. et al. How do pre-operative intra-articular injections impact periprosthetic joint infection risk following primary total hip arthroplasty? A systematic review and meta-analysis. Arch Orthop Trauma Surg 143, 1627–1635 (2023). https://doi.org/10.1007/s00402-022-04375-8

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