A Safe Interval between Preoperative Intra-articular Corticosteroid Injections and Subsequent Knee Arthroscopy

Abstract

The purpose of this study is to evaluate the influence of intra-articular corticosteroid injections prior to knee arthroscopy on the rate of postoperative infection and define a safe timing interval between intra-articular corticosteroid injections and subsequent knee arthroscopy. The PearlDiver Database was used to identify patients who underwent a knee arthroscopy from 2007 to 2017. Patients were sorted into an injection cohort if they received any intra-articular corticosteroid injections within 6 months before surgery and a control cohort if they received no such injections. The injection cohort was then stratified into subgroups based on the timing of the most recent injection. We identified two types of postoperative infection in the 6 months following surgery: a broad definition of infection using knee infection diagnoses, and a narrow definition of infection requiring surgical treatment. The effects of the timing of preoperative corticosteroid injections on the rates of postoperative infection were investigated. The rate of broadly defined postoperative infection was significantly higher in the 0 to 2 weeks injection group (6.90%, 20/290) than the control group (2.01%, 1,449/72,089, p < 0.001; odds ratio [OR]:3.61 [95% confidence interval [CI]: 2.29, 5.70]). We observed a significant difference regarding the rate of narrowly defined postoperative infection requiring surgical treatment between the 0 and 2 weeks injection group (1.38%, 4/290) and the control group (0.27%, 192/72,089, p < 0.001, OR:5.24 [95% CI: 1.94, 14.21]). No significant differences were observed between other subgroups and the control group in both types of postoperative infection. Intra-articular corticosteroid injections within 2 weeks of knee arthroscopy were statistically significantly associated with higher rates of postoperative infection. This is a Level III, retrospective comparative study.

Keywords

knee arthroscopy - corticosteroid - injection - infection

Publikationsverlauf

Eingereicht: 20. Dezember 2019

Angenommen: 14. April 2020

Artikel online veröffentlicht:
08. Juni 2020

• References

• 1 Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 2009; (11) 1-25
• 2 Garrett Jr WE, Swiontkowski MF, Weinstein JN. et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am 2006; 88 (03) 660-667
• 3 Potts A, Harrast JJ, Harner CD, Miniaci A, Jones MH. Practice patterns for arthroscopy of osteoarthritis of the knee in the United States. Am J Sports Med 2012; 40 (06) 1247-1251
• 4 Committee on Complications of Arthroscopy Association of North America. Complications of arthroscopy and arthroscopic surgery: results of a national survey. Arthroscopy 1985; 1 (04) 214-220
• 5 Armstrong RW, Bolding F, Joseph R. Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 1992; 8 (02) 213-223
• 6 Balato G, Di Donato SL, Ascione T. et al. Knee septic arthritis after arthroscopy: incidence, risk factors, functional outcome, and infection eradication rate. Joints 2017; 5 (02) 107-113
• 7 Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary?. Arthroscopy 2007; 23 (01) 4-6
• 8 Cancienne JM, Mahon HS, Dempsey IJ, Miller MD, Werner BC. Patient-related risk factors for infection following knee arthroscopy: an analysis of over 700,000 patients from two large databases. Knee 2017; 24 (03) 594-600
• 9 D'Angelo GL, Ogilvie-Harris DJ. Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis. Arthroscopy 1988; 4 (01) 10-14
• 10 Martin CT, Pugely AJ, Gao Y, Wolf BR. Risk factors for thirty-day morbidity and mortality following knee arthroscopy: a review of 12,271 patients from the national surgical quality improvement program database. J Bone Joint Surg Am 2013; 95 (14) e98 , 1–10
• 11 Sherman OH, Fox JM, Snyder SJ. et al. Arthroscopy--“no-problem surgery”. An analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg Am 1986; 68 (02) 256-265
• 12 Yeranosian MG, Arshi A, Terrell RD, Wang JC, McAllister DR, Petrigliano FA. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. Am J Sports Med 2014; 42 (02) 437-441
• 13 Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ 2004; 328 (7444): 869
• 14 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; (02) CD005328 . Doi: 10.1002/14651858.CD005328.pub2.Cd005328
• 15 Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg 2009; 17 (10) 638-646
• 16 Pekarek B, Osher L, Buck S, Bowen M. Intra-articular corticosteroid injections: a critical literature review with up-to-date findings. Foot 2011; 21 (02) 66-70
• 17 Hiemstra LA, Macdonald PB, Froese W. Subacromial infection following corticosteroid injection. J Shoulder Elbow Surg 2003; 12 (01) 91-93
• 18 Teoh KH, Jones SA, Gurunaidu S, Pritchard MG. Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases). Shoulder Elbow 2015; 7 (03) 182-186
• 19 Caldwell JR. Intra-articular corticosteroids. Guide to selection and indications for use. Drugs 1996; 52 (04) 507-514
• 20 Omar M, Haas P, Ettinger M, Krettek C, Petri M. Simultaneous bilateral quadriceps tendon rupture following long-term low-dose nasal corticosteroid application. Case Rep Orthop 2013; 2013: 657845
• 21 Zhang B, Hu ST, Zhang YZ. Spontaneous rupture of multiple extensor tendons following repeated steroid injections: a case report. Orthop Surg 2012; 4 (02) 118-121
• 22 Brand C. Intra-articular and soft tissue injections. Aust Fam Physician 1990; 19 (05) 671-675 , 678, 680–682
• 23 Clement RC, Haddix KP, Creighton RA, Spang JT, Tennant JN, Kamath GV. Risk factors for infection after knee arthroscopy: analysis of 595,083 cases from 3 United States databases. Arthroscopy 2016; 32 (12) 2556-2561
• 24 Xu C, Peng H, Li R. et al. Risk factors and clinical characteristics of deep knee infection in patients with intra-articular injections: a matched retrospective cohort analysis. Semin Arthritis Rheum 2018; 47 (06) 911-916
• 25 Cancienne JM, Gwathmey FW, Werner BC. Intraoperative corticosteroid injection at the time of knee arthroscopy is associated with increased postoperative infection rates in a large Medicare population. Arthroscopy 2016; 32 (01) 90-95
• 26 Cancienne JM, Kew ME, Smith MK, Carson EW, Miller MD, Werner BC. The timing of corticosteroid injections following simple knee arthroscopy is associated with infection risk. Arthroscopy 2019; 35 (06) 1688-1694
• 27 Werner BC, Cancienne JM, Burrus MT, Park JS, Perumal V, Cooper MT. Risk of infection after intra-articular steroid injection at the time of ankle arthroscopy in a Medicare population. Arthroscopy 2016; 32 (02) 350-354
• 28 Camp CL, Cancienne JM, Degen RM, Dines JS, Altchek DW, Werner BC. Factors that increase the risk of infection after elbow arthroscopy: analysis of patient demographics, medical comorbidities, and steroid injections in 2,704 Medicare patients. Arthroscopy 2017; 33 (06) 1175-1179
• 29 Nelson GN, Wu T, Galatz LM, Yamaguchi K, Keener JD. Elbow arthroscopy: early complications and associated risk factors. J Shoulder Elbow Surg 2014; 23 (02) 273-278
• 30 Wang D, Camp CL, Ranawat AS, Coleman SH, Kelly BT, Werner BC. The timing of hip arthroscopy after intra-articular hip injection affects postoperative infection risk. Arthroscopy 2017; 33 (11) 1988-1994.e1
• 31 Forsythe B, Agarwalla A, Puzzitiello RN, Sumner S, Romeo AA, Mascarenhas R. The timing of injections prior to arthroscopic rotator cuff repair impacts the risk of surgical site infection. J Bone Joint Surg Am 2019; 101 (08) 682-687
• 32 Cancienne JM, Brockmeier SF, Carson EW, Werner BC. Risk factors for infection after shoulder arthroscopy in a large Medicare population. Am J Sports Med 2018; 46 (04) 809-814