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Knee Arthrocentesis in Adults
Published on: February 25, 2022
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Delaying Total Knee Arthroplasty More than 4 Weeks after Intra-Articular Knee Injection Does Not Further Decrease
Sandeep S Bains1, Zhongming Chen1, Oliver C Sax1
1LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
The Journal of Knee Surgery
|December 20, 2022
Summary
Intra-articular knee injections within 4 weeks of total knee arthroplasty (TKA) significantly increase infection risk. Waiting at least 4 weeks between injection and TKA, and avoiding tobacco use, can reduce the likelihood of prosthetic joint infection (PJI).
Area of Science:
- Orthopedic surgery
- Infectious disease
- Rheumatology
Background:
- Intra-articular hyaluronic acid (HA) and corticosteroid (CS) injections are common for osteoarthritis symptom management.
- Concerns exist regarding potential joint contamination from injections, increasing infection risk after total knee arthroplasty (TKA).
Purpose of the Study:
- To evaluate the association between pre-TKA intra-articular knee injections (HA and CS) and the risk of surgical site infection (SSI), manipulation under anesthesia (MUA), and prosthetic joint infection (PJI).
- To assess the impact of injection timing (within 4 weeks, 4-6 weeks) and type (HA vs. CS) on post-TKA infection outcomes.
- To identify risk factors, such as tobacco use, associated with post-TKA infections in patients receiving prior knee injections.
Main Methods:
- A national database was queried for patients undergoing primary TKA between September 2015 and October 2020 (n=1.5 million).
- Patients were stratified into five cohorts: HA within 4 weeks, HA 4-6 weeks prior, CS within 4 weeks, CS 4-6 weeks prior, and a no-injection control group.
- Bivariate chi-square analyses and multivariate regressions were used to assess outcomes (SSI, MUA, PJI) and adjust for comorbidities.
Main Results:
- Intra-articular knee injections administered within 4 weeks of TKA were associated with a significantly increased risk of infection (p < 0.023).
- Corticosteroid injections within 4 weeks of TKA showed a 1.58-fold increase in SSI risk (p = 0.023).
- No significant difference in MUA risk was observed at 90 days postoperatively (p > 0.212).
- Tobacco use was identified as a significant risk factor for increased PJI likelihood.
- The type of injection (HA vs. CS) did not significantly impact infection risk (p > 0.050).
Conclusions:
- Intra-articular knee injections administered less than 4 weeks before TKA increase the risk of PJI.
- Waiting at least 4 weeks between knee injection and TKA is recommended to decrease the risk of septic revision.
- Tobacco cessation should be encouraged in patients undergoing TKA to mitigate PJI risk.
