Impact of Preoperative Intra-articular Injection on Infection Rates Following Total Knee Arthroplasty: An Analysis of Over 19,000 Patients

Author(s): Justin Turcotte, Jacob Aja, Nandakumar Menon, James MacDonald, Paul King

Background: Studies examining the relationship between timing of intra-articular injections and risk for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) are conflicting.

Methods: The TriNetX Research database was retrospectively queried to evaluate all patients with a diagnosis of osteoarthritis undergoing primary TKA between January 1, 2010 and September 30, 2018. Patients were then grouped based on whether they had a preoperative intra-articular injection of hyaluronic acid or corticosteroid within the three months prior to surgery. Analysis was performed using unmatched and propensity score matched cohorts. The primary endpoint was periprosthetic joint infection within 12 months of surgery.

Results: After propensity score matching for age and comorbidities, no difference in one-year PJI rates was observed between groups (No Injection: 20 PJI (2.21%) vs. Injection: 28 PJI (3.10%), No Injection OR=0.708, p=.244).

Conclusion: After propensity score matching for age and comorbidities, no increased risk in periprosthetic infection rate at one year following TKA was observed between for patients receiving hyaluronic acid, corticosteroid or triamcinolone injection within three months of surgery, compared to those receiving no injections in the three-month preoperative period. A large, multicenter, retrospective review of outcomes is warranted if consensus regarding appropriate preoperative timing of injections is to be reached. We continue to recommend caution in administering injections in the three months prior to surgery until a consensus can be reached.