Preoperative Hip Injections Increase the Rate of Periprosthetic Infection After Total Hip Arthroplasty

William W. Schairer, Benedict U. Nwachukwu, David J. Mayman, Stephen Lyman, Seth A. Jerabek

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background Intraarticular injections are both diagnostic and therapeutic for patients with osteoarthritis. A potential risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) may occur from direct inoculation and/or immune suppression by corticosteroids. Large population-level databases were used to evaluate hip injection on the 1-year rate of PJI in patients undergoing primary THA. Methods State-level ambulatory surgery and inpatient databases for Florida and California (2005-2012) were used to identify primary THA patients with 1-year preoperative and postoperative windows to evaluate possible injections or PJI, respectively. Patients were grouped as no injection or as THA performed 6-12 months, 3-6 months, or 0-3 months after injection. Risk adjustment was performed with multivariable regression. Results A total of 173,958 patients were included; 5421 (3.1%) underwent THA after an injection: 1395 (1.1%) of patients after 6-12 months, 1863 patients after 3-6 months, and 2163 (1.2%) after 0-3 months. In the 0-3 month group, PJI was significantly increased at 3 months (1.58%, P = .015), 6 months (1.76%, P = .022), and 1 year (2.04%, P = .031) compared with the noninjection control group (1.04%, 1.21%, and 1.47%, respectively). There were no differences in the 3- to 6-month and 6- to 12-month injection groups. Conclusion There is an increased risk of PJI when THA is performed within 3 months of hip injection. We recommend that patients and their surgeons consider delaying elective THA until 3 months after an injection to avoid this elevated risk of infection.

Original languageEnglish
Pages (from-to)166-169.e1
JournalJournal of Arthroplasty
Volume31
Issue number9
DOIs
Publication statusPublished - Sep 1 2016

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Arthroplasty
Hip
Injections
Infection
Joints
Databases
Risk Adjustment
Intra-Articular Injections
Ambulatory Surgical Procedures
Osteoarthritis
Inpatients
Adrenal Cortex Hormones
Control Groups
Population

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

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Preoperative Hip Injections Increase the Rate of Periprosthetic Infection After Total Hip Arthroplasty. / Schairer, William W.; Nwachukwu, Benedict U.; Mayman, David J.; Lyman, Stephen; Jerabek, Seth A.

In: Journal of Arthroplasty, Vol. 31, No. 9, 01.09.2016, p. 166-169.e1.

Research output: Contribution to journalArticle

Schairer, William W. ; Nwachukwu, Benedict U. ; Mayman, David J. ; Lyman, Stephen ; Jerabek, Seth A. / Preoperative Hip Injections Increase the Rate of Periprosthetic Infection After Total Hip Arthroplasty. In: Journal of Arthroplasty. 2016 ; Vol. 31, No. 9. pp. 166-169.e1.
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abstract = "Background Intraarticular injections are both diagnostic and therapeutic for patients with osteoarthritis. A potential risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) may occur from direct inoculation and/or immune suppression by corticosteroids. Large population-level databases were used to evaluate hip injection on the 1-year rate of PJI in patients undergoing primary THA. Methods State-level ambulatory surgery and inpatient databases for Florida and California (2005-2012) were used to identify primary THA patients with 1-year preoperative and postoperative windows to evaluate possible injections or PJI, respectively. Patients were grouped as no injection or as THA performed 6-12 months, 3-6 months, or 0-3 months after injection. Risk adjustment was performed with multivariable regression. Results A total of 173,958 patients were included; 5421 (3.1{\%}) underwent THA after an injection: 1395 (1.1{\%}) of patients after 6-12 months, 1863 patients after 3-6 months, and 2163 (1.2{\%}) after 0-3 months. In the 0-3 month group, PJI was significantly increased at 3 months (1.58{\%}, P = .015), 6 months (1.76{\%}, P = .022), and 1 year (2.04{\%}, P = .031) compared with the noninjection control group (1.04{\%}, 1.21{\%}, and 1.47{\%}, respectively). There were no differences in the 3- to 6-month and 6- to 12-month injection groups. Conclusion There is an increased risk of PJI when THA is performed within 3 months of hip injection. We recommend that patients and their surgeons consider delaying elective THA until 3 months after an injection to avoid this elevated risk of infection.",
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N2 - Background Intraarticular injections are both diagnostic and therapeutic for patients with osteoarthritis. A potential risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) may occur from direct inoculation and/or immune suppression by corticosteroids. Large population-level databases were used to evaluate hip injection on the 1-year rate of PJI in patients undergoing primary THA. Methods State-level ambulatory surgery and inpatient databases for Florida and California (2005-2012) were used to identify primary THA patients with 1-year preoperative and postoperative windows to evaluate possible injections or PJI, respectively. Patients were grouped as no injection or as THA performed 6-12 months, 3-6 months, or 0-3 months after injection. Risk adjustment was performed with multivariable regression. Results A total of 173,958 patients were included; 5421 (3.1%) underwent THA after an injection: 1395 (1.1%) of patients after 6-12 months, 1863 patients after 3-6 months, and 2163 (1.2%) after 0-3 months. In the 0-3 month group, PJI was significantly increased at 3 months (1.58%, P = .015), 6 months (1.76%, P = .022), and 1 year (2.04%, P = .031) compared with the noninjection control group (1.04%, 1.21%, and 1.47%, respectively). There were no differences in the 3- to 6-month and 6- to 12-month injection groups. Conclusion There is an increased risk of PJI when THA is performed within 3 months of hip injection. We recommend that patients and their surgeons consider delaying elective THA until 3 months after an injection to avoid this elevated risk of infection.

AB - Background Intraarticular injections are both diagnostic and therapeutic for patients with osteoarthritis. A potential risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) may occur from direct inoculation and/or immune suppression by corticosteroids. Large population-level databases were used to evaluate hip injection on the 1-year rate of PJI in patients undergoing primary THA. Methods State-level ambulatory surgery and inpatient databases for Florida and California (2005-2012) were used to identify primary THA patients with 1-year preoperative and postoperative windows to evaluate possible injections or PJI, respectively. Patients were grouped as no injection or as THA performed 6-12 months, 3-6 months, or 0-3 months after injection. Risk adjustment was performed with multivariable regression. Results A total of 173,958 patients were included; 5421 (3.1%) underwent THA after an injection: 1395 (1.1%) of patients after 6-12 months, 1863 patients after 3-6 months, and 2163 (1.2%) after 0-3 months. In the 0-3 month group, PJI was significantly increased at 3 months (1.58%, P = .015), 6 months (1.76%, P = .022), and 1 year (2.04%, P = .031) compared with the noninjection control group (1.04%, 1.21%, and 1.47%, respectively). There were no differences in the 3- to 6-month and 6- to 12-month injection groups. Conclusion There is an increased risk of PJI when THA is performed within 3 months of hip injection. We recommend that patients and their surgeons consider delaying elective THA until 3 months after an injection to avoid this elevated risk of infection.

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