195. Does Intra-Articular Corticosteroid Injection in the Pre-Operative Period Increase the Risk of Joint Infection Following Hip or Knee Arthroplasty? A Systematic Review and Meta-Analysis

Ellerby, Nicolas; Hider, Samantha; Mallen, Christian; Belcher, John; Roddy, Edward

Abstract

Background: OA is the commonest arthritis, and is increasing in prevalence. NICE OA guidelines include IA corticosteroid injections as an adjunctive treatment. There are theoretical concerns that their use prior to joint replacement surgery may increase the risk of post-operative infection. The aim of this systematic review was to examine whether IA corticosteroid injection pre-arthroplasty increases the risk of post-operative infection.

Methods: A systematic literature search was undertaken in MEDLINE, EMBASE, CINHAL, AMED, Cochrane library, and Web of Science databases using terms pertaining to corticosteroids, IA injection and joint replacement. Results were screened by title and abstract following the removal of duplicates. During the screening process exclusion and inclusion criteria were applied. Eligible studies were empirical human studies which included IA steroid injection prior to arthroplasty as an exposure and post-arthroplasty infection rates as an outcome. Those that satisfied the criteria underwent full-text review by 2 reviewers; study quality was assessed using Newcastle-Ottawa quality appraisal tools. Risk estimates from each study were compared, with pooled estimates (95% CI) of the risk of post-operative infection calculated using a random effects model. Heterogeneity was assessed visually with Forest plots and numerically with Cochran’s Q test and I2 test.

Results: 61 papers were identified. After abstract screening, 8 papers met the inclusion criteria. 4 additional studies were identified through citation searches. 6 studies pertained to hip replacement and 6 to knee replacement. 3 studies from each were appropriate for meta-analysis. Quality appraisal revealed that many studies lacked a control group (n = 6), some had small sample sizes (n = 36) and some did not specify type of infection (n = 3). For hip replacement, the pooled odds ratio between IA steroid injection and post-operative infection was 1.72 (95% CI 0.54, 4.59), relative risk 1.61 (95% CI 0.94, 2.76) and percentage difference in infection rate between study and control groups 0.04 (95% CI –0.04, 0.11). For knee replacement, pooled odds ratio was 1.57 (95% CI 0.49, 5.03), relative risk 1.58 (95% CI 0.61, 4.08) and percentage difference in infection rate between study and control group was 0.026 (95% CI –0.059, 0.111).

Conclusion: Post-operative infection rate does not appear to increase with prior IA steroid injection, although the methodological quality of studies was generally poor. Larger studies are required to be definitive, but at present, there is no evidence to support delaying arthroplasty after IA steroid injection.

Citation

Ellerby, N., Hider, S., Mallen, C., Belcher, J., & Roddy, E. (2014). 195. Does Intra-Articular Corticosteroid Injection in the Pre-Operative Period Increase the Risk of Joint Infection Following Hip or Knee Arthroplasty? A Systematic Review and Meta-Analysis. Rheumatology, 53(suppl_1), i132-i132. https://doi.org/10.1093/rheumatology/keu112.003

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 7, 2014
• Publication Date: 2014-04
• Deposit Date: Aug 25, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 53
• Issue: suppl_1
• Pages: i132-i132
• DOI: https://doi.org/10.1093/rheumatology/keu112.003
• Keywords: Pharmacology (medical); Rheumatology