Do preoperative intra-articular injections of corticosteroids or hyaluronic acid increase the risk of infection after total knee arthroplasty? A meta-analysis

Bone & Joint Research

article

Xurong Yang¹  Li Li¹  Xiaonan Ren²  Lixiong Nie¹ 

[1] Jiangle County General Hospital;Department of Rehabilitation, Mawei District Hospital

关键词: Injections;    Arthroplasty;    Knee;    Infections;    Meta-analysis;    Intra-articular injections;    hyaluronic acid (HA);    corticosteroids;    infections;    total knee arthroplasty (TKA);    postoperative infection;    cohort studies;    deep infection;    periprosthetic joint infection (PJI);    superficial infections;   

DOI  :  10.1302/2046-3758.113.BJR-2021-0350.R1

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

AimsThere is conflicting evidence on the safety of intra-articular injections of hyaluronic acid (HA) or corticosteroids (CSs) before total knee arthroplasty (TKA). We performed a meta-analysis of the relationship between intra-articular injections and subsequent infection rates after TKA.MethodsWe searched PubMed, EMBASE, and the Cochrane Library for cohort studies that assessed the effect of preoperative injection of drugs into the joint cavity on the infection rate after TKA. The outcomes analyzed included the total infection rate, as well as those for different preoperative injection time periods and different drugs.ResultsEight studies, including 73,880 in the injection group and 126,187 in the control group, met the inclusion criteria. The injection group had a significantly higher postoperative infection rate than the control group (risk ratio (RR) 1.16; 95% confidence interval (CI) 1.07 to 1.27; p < 0.001; I2 = 32%). For patients who received injections up to three months preoperatively, the postoperative infection risk was significantly higher than that in the control group (RR 1.26; 95% CI 1.18 to 1.35; p＜0.001; I2 = 0%). There was no significant difference in the infection rates between the four-to-six-month injection and control groups (RR 1.12; 95% CI 0.93 to 1.35; p = 0.240; I2 = 75%) or between the seven-to-12-month injection and control groups (RR 1.02; 95% CI 0.94 to 1.12; p = 0.600; I2 = 0%).ConclusionCurrent evidence suggests that intra-articular injections of CSs or HA before TKA increase the risk of postoperative infection. Injections administered more than three months before TKA do not significantly increase the risk of infection.

【 授权许可】

CC BY-NC