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Meta-Analysis
. 2023 Feb 28;18(1):148.
doi: 10.1186/s13018-023-03637-4.

Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis

Young Mo Kim  1 , Yong Bum Joo  1 , Ju-Ho Song  2
Affiliations
Meta-Analysis

Preoperative intra-articular steroid injections within 3 months increase the risk of periprosthetic joint infection in total knee arthroplasty: a systematic review and meta-analysis

Young Mo Kim et al. J Orthop Surg Res. .

Abstract

Objective: Albeit with no disease-modifying effects, intra-articular steroid injections (IASIs) are still widely used to relieve symptoms of knee osteoarthritis. Previous literature has reported conflicting results regarding the safety of IASI in terms of periprosthetic joint infection (PJI) in total knee arthroplasty (TKA). This study tried to determine whether preoperative IASIs increased the risk of PJI, with different time intervals between the injections and surgery.

Methods: A computerized search of MEDLINE, EMBASE, and Cochrane Library was conducted for studies published before October 2022, which investigated the PJI rates of patients who received IASIs before TKA and patients who did not. The primary outcome was the association between preoperative IASI and PJI in TKA. The time point from which IASIs could be applied without risking PJI was also assessed.

Results: Fourteen studies, with 113,032 patients in the IASI group and 256,987 patients in the control group, were included. The pooled odds ratio of PJI was 1.13 (95% confidence interval [CI] 1.00-1.27, p = 0.05), indicating no increased risk of PJI. With the time interval < 6 months, the pooled odds ratio was 1.19 (95% CI 0.99-1.43, p = 0.06). However, with the time interval < 3 months, the pooled odds ratio was 1.26 (95% CI 1.06-1.50, p < 0.01).

Conclusion: IASI is not a safe procedure for patients who are expected to undergo TKA. The time interval between the injections and surgery was an important factor in assessing the safety of IASI. Preoperative injections that were applied within 3 months increased the risk of PJI in TKA.

Keywords: Injection; Periprosthetic joint infection; Steroid; Total knee arthroplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart
Fig. 2
Fig. 2
Traffic light plot regarding risk of bias scores for the included studies
Fig. 3
Fig. 3
Forest plot regarding the overall effect of IASI on the risk of PJI. IASI, intra-articular steroid injection; PJI, periprosthetic joint infection
Fig. 4
Fig. 4
Forest plot regarding the effect of IASI within 6 months on the risk of PJI. IASI, intra-articular steroid injection; PJI, periprosthetic joint infection
Fig. 5
Fig. 5
Forest plot regarding the effect of IASI within 3 months on the risk of PJI. IASI, intra-articular steroid injection; PJI, periprosthetic joint infection
See this image and copyright information in PMC

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