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      Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty : is it safe? a systematic review

      Author(s): 1 , 2 , 1
      Publication date Created:
      Publication date (Print):
      Journal: The Bone & Joint Journal
      Publisher: British Editorial Society of Bone & Joint Surgery

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          Abstract

          Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA).

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          Infection of the surgical site after arthroplasty of the hip.

          Antonios G Kafatos, A Charlet, F. Wilson … (2005)
          We wished to estimate the incidence of surgical-site infection (SSI) after total hip replacement (THR) and hemiarthroplasty and its strength of association with major risk factors. The SSI surveillance service prospectively gathered clinical, operative and infection data on inpatients from 102 hospitals in England during a four-year period. The overall incidence of SSI was 2.23% for 16,291 THRs, 4.97% for 5769 hemiarthroplasty procedures, 3.68% for 2550 revision THRs and 7.6% for 198 revision hemiarthroplasties. Staphylococcus aureus was identified in 50% of SSIs; 59% of these isolates were methicillin-resistant (MRSA). In the single variable analysis of THRs, age, female gender, American Society of Anesthesiologists (ASA) score, body mass index, trauma, duration of operation and pre-operative stay were significantly associated with the risk of SSI (p < 0.05). For hemiarthroplasty, the ASA score and age were significant factors. In revision THRs male gender, ASA score, trauma, wound class, duration of operation and pre-operative stay were significant risk factors. The median time to detection of SSI was eight days for superficial incisional, 11 days for deep incisional and 11 days for joint/bone infections. For each procedure the mean length of stay doubled for patients with SSI. The multivariate analysis identified age group, trauma, duration of operation and ASA score as significant, independent risk factors for SSI. There was significant interhospital variation in the rates of SSI. MRSA was the most common pathogen to cause SSI in hip arthroplasty, especially in patients undergoing hemiarthroplasty, but coagulase-negative Staph. aureus may be more important in deep infections involving the joint.
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            Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systematic review.

            Anita Wluka, Donna M Urquhart, Penelope E. Graves … (2010)
            Although deep surgical site infection (SSI) is a major complication of primary total hip arthroplasty (THA), there are conflicting data regarding the incidence of deep SSI, and no comprehensive evaluation of the associated risk factors has been undertaken. We performed a systematic review of the literature; undertaking computer-aided searches of electronic databases, assessment of methodological quality, and a best-evidence synthesis. The incidence of SSI ranged from 0.2% before discharge to 1.1% for the period up to and including 5 years post surgery. Greater severity of a pre-existing illness and a longer duration of surgery were found to be independent risk factors for deep SSI. There is a need for high-quality, prospective studies to further identify modifiable risk factors for deep SSI after THA. Crown Copyright © 2010. Published by Elsevier Inc. All rights reserved.
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              Intraoperative bacterial contamination in operations for joint replacement.

              William P. Kay, A Gambhir, Sarah Wilkins … (1999)
              All surgical operations have the potential for contamination, and the equipment used can harbour bacteria. We collected samples from 100 elective primary hip and knee arthroplasties. These showed rates of contamination of 11.4% for the sucker tips, 14.5% for light handles, 9.4% for skin blades and 3.2% for the inside blades used during surgery; 28.7% of gloves used for preparation were also contaminated. Of the samples taken from the collection bags used during hip arthroplasty, 20% grew bacteria, which represents a significant microbial reservoir. Also, 17% of theatre gowns were contaminated at the end of the operation. Contamination was found in 10% of the needles used during closure of the fascia. Overall, 76% of the organisms grown were coagulase-negative staphylococcus. A total of 63% of operations showed contamination in the field of operation. Some changes in practice are suggested. Follow-up for a minimum of two years revealed one deep infection but the organism was not identified as a contaminant. These data provide a baseline for studying the bacteriology of the surgery of revision arthroplasty.
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                Author and article information

                Journal
                Title: The Bone & Joint Journal
                Abbreviated Title: The Bone & Joint Journal
                Publisher: British Editorial Society of Bone & Joint Surgery
                ISSN (Print): 2049-4394
                ISSN (Electronic): 2049-4408
                Publication date Created: August 2016
                Publication date (Print): August 2016
                Volume: 98-B
                Issue: 8
                Pages: 1027-1035
                Affiliations
                [1 ]Centre Hospitalier Universitaire Vaudois, Site Hôpital Orthopédique, Avenue Pierre Decker 4, CH-1011 Lausanne, Switzerland.
                [2 ]Therap-ease Treatment Centre, 382 Morningside Road, Edinburgh, EH10 5HX, UK.
                Article
                DOI: 10.1302/0301-620X.98B8.37420
                PubMed ID: 27482013
                SO-VID: cb19db16-e552-45da-9c1c-2609634e1a8d
                Copyright © © 2016
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