Risk analysis of periprosthetic knee joint infection (PJI) in total knee arthroplasty after preoperative corticosteroid injection: a systematic review

• Published in: Archives of orthopaedic and trauma surgery Vol. 143; no. 5; pp. 2683 - 2691
• Main Authors: Baums, M. H, Aquilina, J, Pérez-Prieto, D, Sleiman, O, Geropoulos, G, Totlis, T
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Nature B.V 01.05.2023
• Subjects: Infections; Joint replacement surgery; Knee; Steroids
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-022-04532-z

PurposeIntra-articular corticosteroid injection is widely used for symptomatic relief of knee osteoarthritis. However, if pain is not improved which consequences a total knee arthroplasty (TKA), there is a potential risk of post-operative periprosthetic joint infection (PJI). The aim of this study is to investigate whether the use of preoperative intra-articular corticosteroid injection increases the risk of PJI and to investigate a time frame in which the risk of subsequent infection is significantly increased. MethodsA systematic search was performed in PubMed (Medline), Scopus, and the Cochrane Library. Inclusion criteria were original studies investigating the rate of PJI in patients receiving pre-operative intra-articular corticosteroid injection compared to controls. ResultsA total of 380 unique articles were screened. Six studies met the inclusion criteria with 255,627 patients in total. Overall, no statistical significance was observed in the intra-articular infection rate in corticosteroid compared to controls groups. However, intra-articular corticosteroid injections within 3 months prior to TKA were associated with a significantly increased risk of infection (OR: 1.52, 95% CI 1.37–1.67, p < 0.01); this was not observed in the 6 month period (OR: 1.05, 95% CI 0.80–1.39, p = 0.72). ConclusionsPerforming an intra-articular corticosteroid injection within 3 months prior to TKA is associated with a significantly increased risk of PJI. The current evidence supports the safe use of intra-articular corticosteroid injection more than 6 months before TKA. However, additional studies are needed to clarify the risk of PJI after TKA implantation between 3 and 6 months after the last corticoid injection. Level of evidenceIV.