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. 2021 Jan 23:16:49-57.
doi: 10.1016/j.jcot.2020.12.016. eCollection 2021 May.

Do preoperative intra-articular corticosteroid and hyaluronic acid injections affect time to total joint arthroplasty?

Alex Tang  1 , Omar Almetwali  1 , Stephen G Zak  1 , Jenna A Bernstein  1 , Ran Schwarzkopf  1 , Vinay K Aggarwal  1
Affiliations

Do preoperative intra-articular corticosteroid and hyaluronic acid injections affect time to total joint arthroplasty?

Alex Tang et al. J Clin Orthop Trauma. .

Erratum in

  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Orthop Trauma. 2021 Aug 5;21:101558. doi: 10.1016/j.jcot.2021.101558. eCollection 2021 Oct. J Clin Orthop Trauma. 2021. PMID: 34414072 Free PMC article.

Abstract

Introduction: Intra-articular corticosteroid (CSI) or hyaluronic acid (HAI) injections alleviate symptoms of osteoarthritis in patients who may be candidates for total hip or total knee arthroplasty (THA/TKA). However, their effect on time to total joint arthroplasty (TJA) and complications remains uncertain. We sought to evaluate (1) delay in time to surgery for patients receiving injections prior to THA/TKA (2) incidence of patients that receive injections, (3) type and number of injections, and (4) compare complication rates between patients with and without injections.

Methods: We retrospectively reviewed 3340 consecutive TJA (1770 THA and 1570 TKA). Patients were divided into two cohorts depending if they received preoperative intra-articular injection or not. We identified dates of first clinic presentation and index surgery, injection type, total administered, and 90-day complications, including periprosthetic joint infection.

Results: 150/1770 THA and 192/1570 TKA patients received injections (8.5%vs.12.2%,p = 0.0004). Time from first presentation to clinic to TJA was significantly greater in patients receiving injections [12.4 ± 11 months vs.7.3 ± 10.7,p < 0.001 for THA; 20.0 ± 17.4 months vs.11.6 ± 15.4,p < 0.001 for TKA]. This delay in time was greater in TKA versus THA (8.4 months vs.5.1,p < 0.001). TKA patients had a higher incidence of receiving HAI versus THA patients (9%vs.0.6%,p < 0.0001). There were no differences in overall complication profiles (p = 0.19 for THA, p = 0.3 for TKA).

Conclusion: Injections are associated with an increased time to TJA by a statistically significant amount, however its clinical significance is debatable. Injections are safe if administered at least three months preoperatively. If patients present with appropriate surgical indications and are ready, we do not recommend intra-articular injections to delay surgery.

Keywords: Complications; Corticosteroids; Hyaluronic acid; Intra-articular injection; Total joint arthroplasty.

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Figures

Fig. 1
Fig. 1
Patient inclusion/exclusion Criteria.
See this image and copyright information in PMC

References

    1. Chandrasekaran S., Lodhia P., Suarez-Ahedo C., Vemula S.P., Martin T.J., Domb B.G. Symposium: evidence for the use of intra-articular cortisone or hyaluronic acid injection in the hip. J Hip Preserv Surg. 2016;3 doi: 10.1093/JHPS/HNV020. - DOI - PMC - PubMed
    1. Cole B.J., Schumacher H.R. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13:37–46. doi: 10.5435/00124635-200501000-00006. - DOI - PubMed
    1. Crawford R.W., Gie G.A., Ling R.S., Murray D.W. Diagnostic value of intra-articular anaesthetic in primary osteoarthritis of the hip. J Bone Joint Surg Br. 1998;80:279–281. doi: 10.1302/0301-620x.80b2.8299. - DOI - PubMed
    1. Kleiner J.B., Thorne R.P., Curd J.G. The value of bupivicaine hip injection in the differentiation of coxarthrosis from lower extremity neuropathy. J Rheumatol. 1991;18:422–427. - PubMed
    1. Faraj A.A., Kumaraguru P., Kosygan K. Intra-articular bupivacaine hip injection in differentiation of coxarthrosis from referred thigh pain: a 10 year study. Acta Orthop Belg. 2003;69:518–521. - PubMed

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