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

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-05-15T21:30:19+05:30 | Updated On 15 May 2022 9:33 PM IST

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.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751