Intra-Articular Corticosteroid Injection After Total Knee Replacement: Is it Safe?

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology

Background:

• Recalcitrant pain post-total knee replacement (TKR) is often managed with intra-articular steroid injections (IASI).
• The risk of subsequent periprosthetic joint infection (PJI) following IASI in TKRs is not well-established.

Purpose of the Study:

• To systematically review and evaluate the incidence and risk of PJI after intra-articular steroid injections into total knee replacements.

Main Methods:

• A systematic literature search was conducted across multiple databases (PubMed, Embase, Web of Science, CINAHL, Google Scholar) using relevant keywords.
• Four articles met the inclusion criteria for evaluation and statistical analysis; no Level I or II studies were identified.

Main Results:

• The incidence of PJI at 12 months post-IASI was 2.1% (138/6499), compared to 1.4% (158/11256) in controls.
• A chi-square test indicated a statistically significant difference in infection rates (p = 0.0002424), though sample size is a consideration.

Conclusions:

• Intra-articular steroid injections into total knee replacements are not a benign procedure.
• IASI may be associated with a significantly increased risk of subsequent periprosthetic joint infection.
• Recommendations are against IASI in TKRs until further studies clarify safety and efficacy.