Is the infection rate in primary THA increased after steroid injection?

Injection of the hip is performed for diagnostic and therapeutic reasons. Articular cartilage deterioration and increased risk of prosthetic infection have been reported with steroid injections. However, the literature contains contradictory reports on an increased risk of infection after a subsequent THA.

We asked whether intraarticular steroid injection increased the rate of infection of a subsequent THA.

We retrospectively reviewed records of 175 patients in whom intraarticular steroid injections were given under strictly aseptic conditions using a lateral approach within 1 year before THA. These patients were matched with others from our database who had not received an injection for comorbidities, and for American Society of Anesthesiologists score, age, BMI, sex, type of implant, and year of THA.

We found no differences in the rate of deep or superficial infection between the two groups. One patient in the injected group and one in the control group had a late chronic infection. In three patients in the injected group and one in the control group, one of the intraoperative cultures was positive. Five patients in the injected group and seven in the control group had superficial infections develop. In seven patients in the injected group and five in the control group, there was prolonged wound drainage (> 5 days). None of these patients had a deep wound infection at latest followup.

When used in strictly aseptic conditions, intraarticular steroid injection of the hip did not increase the risk of infection in patients subsequently undergoing THA.

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.