Intra-Articular Corticosteroid or Hyaluronic Acid Injections Are Not Associated with Periprosthetic Joint Infection Risk following Total Knee Arthroplasty
This study evaluated whether the preoperative use and timing of the use of hyaluronic acid (HA) and/or corticosteroid (CS) injections were associated with an increased risk of periprosthetic joint infections (PJIs) following primary total knee arthroplasty (TKA). We tested the hypothesis that preoperative injection of HA or CS within 3 months prior to primary TKA was associated with an increased risk of PJI by specifically evaluating the association between PJI risk and (1) injection type; (2) timing; (3) patient demographic factors; and (4) surgery-related factors, such as surgeon injection volume, knee arthroscopy (pre- and postoperative), and hospital length of stay. The 5% Medicare part B claims database was queried for patients who received CS and/or HA injections. Cox proportional hazards regressions evaluated the risk of PJIs after TKA, adjusting for patient and clinical factors, as well as propensity scores. The unadjusted incidence of PJI at 2-year post-TKA was 0.75% for the CS group, 0.89% for the HA group, 0.96% for both CS and HA group, and 0.75% for those who did not use HA or CS in the 12 months before TKA. For patients who used HA and/or CS within 3 months prior to TKA, the unadjusted incidence of PJI at 2-year post-TKA was 0.75% for the CS group, 1.07% for the HA group, and 1.00% for both CS and HA group, compared with 0.77% for those who did not use HA or CS. The number of injections performed per year was inconsistently associated with PJI risk. Overall, we ...
ConclusionThis randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program.Level of evidenceI.
Intra-articular corticosteroids are useful for acute and short-term pain relief, whereas hyaluronic acid is useful for a longer-term treatment effect for patients with knee osteoarthritis. More rigorous research using homogeneous preparations and techniques and randomizing larger numbers of knee osteoarthritis patients are warranted before recommending any wider acceptance of platelet-rich plasma and stem cell therapies. This is of utmost importance, especially with several new injectables such as anti –nerve growth factor antibodies, Wnt pathway inhibitors, and capsaicin showing promise to enter the market soon.
Intra-articular corticosteroids are useful for acute and short-term pain relief, whereas hyaluronic acid is useful for a longer-term treatment effect for patients with knee osteoarthritis. More rigorous research using homogenous preparations and techniques, randomizing larger numbers of knee osteoarthritis patients are warranted before recommending any wider acceptance of platelet-rich plasma and stem cell therapies. This is of utmost importance especially with several new injectables such as anti-nerve growth factor antibodies, Wnt pathway inhibitors and capsaicin showing promise to enter the market soon.
CONCLUSION: Moderate- to very-low-quality evidence suggests large effects of physiotherapy modalities plus exercise and suprascapular nerve block, and trivial to small effects for surgical interventions for improving shoulder pain in patients with diabetes. Future well-designed studies are needed to provide accurate estimates of the true effects of these interventions on improving shoulder pain in patients with diabetes. Implications For Rehabilitation Shoulder pain may lead to disability in patients with diabetes. We recommend the use of physiotherapy interventions to reduce shoulder pain. Corticosteroid injections are re...
Publication date: Available online 18 August 2020Source: Orthopaedics &Traumatology: Surgery &ResearchAuthor(s): Alan Perdreau, Christophe Duysens, Thierry Joudet
ConclusionThose 25 recommendations should standardize and facilitate the use of IA PRP injections, which are considered by experts as an effective treatment especially in early or moderate knee OA. Although a strong or relative agreement from the experts was obtained for most of the recommendations, many of them had a very low level of evidence (Level 5) and were principally based on the clinical experience of the experts.
J Knee Surg DOI: 10.1055/s-0040-1712949The purpose of this study is to evaluate the influence of intra-articular corticosteroid injections prior to knee arthroscopy on the rate of postoperative infection and define a safe timing interval between intra-articular corticosteroid injections and subsequent knee arthroscopy. The PearlDiver Database was used to identify patients who underwent a knee arthroscopy from 2007 to 2017. Patients were sorted into an injection cohort if they received any intra-articular corticosteroid injections within 6 months before surgery and a control cohort if they received no such injections. The i...
To synthesize the clinical outcome data of preoperative and postoperative corticosteroid injections (CIs) and their effect on rotator cuff repairs (RCRs).
To synthesize the clinical outcome data of pre-operative and post-operative corticosteroid injections and their effect on rotator cuff repairs.
ConclusionsAdding corticosteroids to an analgesic cocktail for PIA could lightly improve early pain relief and accelerate recovery in the first 24 h after TKA.Level of evidenceRandomized controlled trial, Level I.