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Related Experiment Video

Updated: Sep 19, 2025

Knee Arthrocentesis in Adults
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Does a Simple Needle Stick From a Preoperative Knee Aspiration or Non-Steroidal Injection Influence Total Knee

Hania Shahzad1, Christopher A Krajcir2, John P Meehan1

  • 1Department of Orthopedics, University of California Davis Health, Sacramento, California.

The Journal of Arthroplasty
|June 4, 2025
PubMed
Summary

Intra-articular injections (IAIs) before total knee arthroplasty (TKA) increase infection risk, even without corticosteroids. Postponing TKA for at least 3 months after any IAI is recommended to reduce infection rates.

Keywords:
intra-articular injectionknee aspirationnon-steroidal injectionprosthetic joint infectiontotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Biomedical Data Science

Background:

  • Intra-articular injections (IAIs) of corticosteroids before total knee arthroplasty (TKA) are linked to higher post-TKA infection risks.
  • Proposed mechanisms include local immunosuppression and physical barrier disruption.
  • The risk associated with non-corticosteroid IAIs or simple aspirations remains unclear.

Purpose of the Study:

  • To investigate the association between the timing of non-corticosteroid IAIs and the risk of post-TKA infection.
  • To determine if simple aspirations or non-corticosteroid injections increase infection risk compared to no injections before TKA.

Main Methods:

  • Analysis of a national claims database (>42 million records) for TKA procedures between 2017-2022.
  • Identification of patients receiving IAIs (platelet-rich plasma, stem cells, ketorolac, aspiration) within 6 months before TKA.
  • Stratification of patients based on the timing of the last IAI (1, 3, or 6 months prior to TKA).

Main Results:

  • Of 232,342 TKA patients, 8,019 (3.5%) received IAIs within 6 months.
  • Infection rates requiring surgical debridement were highest with IAIs within 1 month (7.6%), followed by 3 months (4.6%), and 6 months (2.2%).
  • Patients with no IAIs within 6 months had the lowest infection rate (1.4%).

Conclusions:

  • IAIs/aspirations before TKA elevate infection risk, irrespective of corticosteroid content.
  • The risk is particularly pronounced when IAIs are administered within 3 months of TKA.
  • Surgeons should consider delaying TKA for up to 3 months following any IAI to mitigate infection risk.