Does Surgical Approach in Total Hip Arthroplasty Affect Postoperative Corticosteroid Injection Requirements?

Corticosteroid injections following total hip arthroplasty (THA) are commonly used to address soft tissue pathology such as bursitis and tendinitis. The THA surgical approaches differ in the extent of muscle and soft tissue dissection. The aim of this study was to compare the impact of surgical approach on postoperative corticosteroid injection requirements when controlling for multiple covariates. A secondary aim was to identify risk factors associated with the various injection types.

This was a propensity-matched retrospective study of 10,907 THA patients from June 2016 to December 2022 at a single urban academic health center. Patients were stratified into cohorts based on the following surgical approaches: anterior (n = 4,287) and posterior (n = 6,620), then propensity-matched 1:1 with nearest neighbor matching to form two cohorts of 4,287 patients. Baseline characteristics and corticosteroid injection data for soft-tissue pathology were obtained and analyzed. Chi-square and multivariate logistic regression analyses were used to assess the impact of patient and surgical factors on receiving postoperative steroid injections.

A posterior approach conferred increased risk of postoperative injections (adjusted odds ratio 1.242, P = 0.001) after controlling for multiple covariates. The posterior approach also had higher total rates of greater trochanter bursitis injections postoperatively compared to the anterior group (11.5 versus 7.3%, P < 0.001). Both surgical approaches demonstrated comparable rates of iliopsoas bursitis injections (P = 0.39), gluteus medius tendinosis injections (P = 0.09), and lateral femoral cutaneous nerve injections (P = 0.27). The strongest predictor of postoperative injections was a history of preoperative injection (adjusted odds ratio 3.772, P < 0.001).

Posterior approach, women, and history of preoperative corticosteroid injection were identified as the strongest risk factors for postoperative greater trochanter bursitis injection or postoperative soft tissue injection. These factors should be considered when counseling patients on expected postoperative outcomes and the likelihood of corticosteroid injections following THA.