Wednesday, May 27, 2020

Should the painful shoulder arthroplasty be injected with corticosteroids?

The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty

These authors sought to determine the risk of early infection following intra-articular corticosteroid injection into a pre-existing shoulder arthroplasty. They reviewed the PearlDiver database  to identify patients having a shoulder arthroplasty from 2007 to 2017. Patients with an ipsilateral shoulder corticosteroid injection in the postoperative period were identified. A control group of patients without an injection was matched 4:1 by age, gender, and postoperative timepoint. Periprosthetic infection within six months after the injection was then assessed and compared using a logistic regression analysis.

Nine hundred and fifty-eight patients were identified who underwent a postoperative corticosteroid injection into a pre-existing shoulder arthroplasty were compared to 3832 control patients.

After controlling for demographics, comorbidities, and procedure type, the rate of infection in patients who received a postoperative corticosteroid injection (1.77%) was significantly higher than control patients who did not receive an injection (0.91%) (OR 1.98 (95% CI 1.31–2.98), p.0.0253).

Comment: The authors suggest that the two-fold increase in infection rate associated with steroid injection may be due to one of the following: (1) The etiology of the pain may itself be an indolent infection, and the injection is given in the presence of a low-grade infection that disrupts the body’s immune response to fight the infection leading to more systemic symptoms. (2) The injection introduces a bacterial contamination, resulting in prosthetic joint infection.

It is of interest that the patients receiving steroid injections were more likely to have diabetes, hyperlipidemia, peripheral vascular disease, chronic lung disease, and depression. These co-morbidities may have contributed to the increased infection rate as well. It is of interest that physicians appear to be more likely to inject shoulder arthroplasties in patients who are chronically ill.

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