Cumulative Intraarticular Injections Are Not linked to Joint Infections Following TKA: JOA study

Philadelphia, PA: Periprosthetic joint infection (PJI) is an uncommon but severe complication following TKA, resulting in diminished quality of life and increased mortality Although corticosteroid injections prior to TKA have been linked to PJI, there is considerable debate in the literature regarding this topic.

While injections within 90 days prior to total knee arthroplasty (TKA) are associated with an increased risk of periprosthetic joint infection (PJI), there is a paucity of literature regarding the impact of cumulative injections on PJI risk. A study was conducted by I.A. Khan et al. to assess the association between cumulative corticosteroid and hyaluronic acid (HA) injections and PJI risk following TKA.

A retrospective study was done using an injection database included patients undergoing TKA with a minimum 1-year follow-up from 2015 to 2020. Patients with injections within 90 days prior to surgery were excluded. The sum of corticosteroid and HA injections within five years prior to TKA was recorded. The primary outcome was PJI within 90 days following TKA. Area under the curve (AUC) values were calculated for a cumulative number of injections.

The results of the study were :

• 648 knees with no injections and 672 knees with injections prior to TKA were included, among whom 243 received corticosteroids, 151 received HA, and 278 received both.

• No significant differences in early PJI rates existed between patients who received injections (0.60%) or not (0.93%) (P = .541).

• No significant differences existed in early PJI rates between patients injected with corticosteroids (0.82%), HA (0.66%), or both (0.36%) (P = .832).

• No cutoff number of injections was predictive for PJI.

The authors concluded that - patients receiving corticosteroid injections, hyaluronic acid injections, or injections of both more than 90 days prior to TKA did not have an increased risk of PJI at 90 days and 1 year postoperatively. Additionally, the cumulative number of injections was not predictive of PJI at 90 days and 1 year postoperatively. While this study provides preliminary evidence that intraarticular HA and corticosteroid injections more than 90 days prior to TKA may be used in a cumulative fashion without significantly increasing the risk of PJI, further studies with larger sample sizes are needed to validate these findings.

Further reading:

Cumulative Intraarticular Injections Are Not a Risk Factor for Periprosthetic Joint Infection Following total Knee Arthroplasty

Irfan A. Khan, Ilan Small, Ryan M. Sutton, Graham S. Goh, Matthew B. Sherman, Donald W. Mazur, Yale A. Fillingham.

The Journal of Arthroplasty 37 (2022) 1059- 1063

https://doi.org/10.1016/j.arth.2022.02.027