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Corticosteroid Injections 1 Month Before Arthroscopic Meniscectomy Increase the Risk of Surgical-Site Infection

      Purpose

      To define the incidence of postoperative infections in patients who receive corticosteroid injections prior to arthroscopic meniscectomy, to determine whether there is a temporal relation between injections and the risk of surgical-site infections, and to identify corresponding risk factors.

      Methods

      The Humana administrative claims database was reviewed for patients undergoing arthroscopic meniscectomy within 1 year of injection and those undergoing arthroscopic meniscectomy without prior injection. Patients with preoperative injections were further stratified by the duration in months between the injection and the surgical procedure. Surgical-site infection within 6 months of surgery was recorded. Univariate analysis and binary logistic regression were performed to determine independent risk factors for surgical-site infection. Statistical significance was defined as P < .05.

      Results

      We identified patients with (n = 11,652) and without (n = 37,261) a history of a knee corticosteroid injection within 1 year of arthroscopic meniscectomy with at least 6 months of database activity from 2007 to 2017. In patients who received knee injections within 1 month prior to surgery, the rate of development of postoperative infections was twice that in patients who did not receive an injection (1.28% vs 0.63%; odds ratio [OR], 1.84; 95% confidence interval [CI], 1.24-2.62; P = .001). Multivariate logistic regression identified male sex (OR, 1.39; 95% CI, 1.14-1.71; P = .001), diabetes (OR, 1.48; 95% CI, 1.19-1.85; P < .001), chronic obstructive pulmonary disease (OR, 1.57; 95% CI, 1.27-1.94; P < .001), obesity (OR, 1.32; 95% CI, 1.07-1.63; P = .010), tobacco use (OR, 1.61; 95% CI, 1.30-1.98; P < .001), and preoperative injections within 1 month of surgery (OR, 1.78; 95% CI, 1.21-2.54; P = .002) as significant predictors, whereas injections administered more than 1 month before surgery were not significantly associated with postoperative surgical-site infection after arthroscopic meniscectomy.

      Conclusions

      Injections 1 month before arthroscopic meniscectomy significantly increase the risk of surgical-site infection. However, injections can be safely administered more than 1 month prior to surgery because there is no increased risk of postoperative infection at this time point.

      Level of Evidence

      Level III, retrospective cohort study.
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      References

        • Clayton R.A.
        • Court-Brown C.M.
        The epidemiology of musculoskeletal tendinous and ligamentous injuries.
        Injury. 2008; 39: 1338-1344
        • Greis P.E.
        • Bardana D.D.
        • Holmstrom M.C.
        • Burks R.T.
        Meniscal injury: I. Basic science and evaluation.
        J Am Acad Orthop Surg. 2002; 10: 168-176
        • Conaghan P.G.
        • Hunter D.J.
        • Cohen S.B.
        • et al.
        Effects of a single intra-articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain: A double-blinded, randomized, placebo-controlled, multinational study.
        J Bone Joint Surg Am. 2018; 100: 666-677
        • Juni P.
        • Hari R.
        • Rutjes A.W.
        • et al.
        Intra-articular corticosteroid for knee osteoarthritis.
        Cochrane Database Syst Rev. 2015; : CD005328
        • Ishikawa K.
        Effect of intra-articular corticosteroid on the meniscus. A histological and histochemical study in rabbit knees.
        J Bone Joint Surg Am. 1981; 63: 120-130
        • Wernecke C.
        • Braun H.J.
        • Dragoo J.L.
        The effect of intra-articular corticosteroids on articular cartilage: A systematic review.
        Orthop J Sports Med. 2015; 3 (2325967115581163)
        • Dragoo J.L.
        • Danial C.M.
        • Braun H.J.
        • Pouliot M.A.
        • Kim H.J.
        The chondrotoxicity of single-dose corticosteroids.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1809-1814
        • Cancienne J.M.
        • Kew M.E.
        • Smith M.K.
        • Carson E.W.
        • Miller M.D.
        • Werner B.C.
        The timing of corticosteroid injections following simple knee arthroscopy is associated with infection risk.
        Arthroscopy. 2019; 35: 1688-1694
        • Cancienne J.M.
        • Gwathmey F.W.
        • Werner B.C.
        Intraoperative corticosteroid injection at the time of knee arthroscopy is associated with increased postoperative infection rates in a large Medicare population.
        Arthroscopy. 2016; 32: 90-95
        • Cancienne J.M.
        • Werner B.C.
        • Luetkemeyer L.M.
        • Browne J.A.
        Does timing of previous intra-articular steroid injection affect the post-operative rate of infection in total knee arthroplasty?.
        J Arthroplasty. 2015; 30: 1879-1882
        • Roecker Z.
        • Quinlan N.D.
        • Browne J.A.
        • Werner B.C.
        Risk of periprosthetic infection following intra-articular corticosteroid injections after total knee arthroplasty.
        J Arthroplasty. 2020; 35: 1090-1094
        • Clement R.C.
        • Haddix K.P.
        • Creighton R.A.
        • Spang J.T.
        • Tennant J.N.
        • Kamath G.V.
        Risk factors for infection after knee arthroscopy: Analysis of 595,083 cases from 3 United States databases.
        Arthroscopy. 2016; 32: 2556-2561
        • Forsythe B.
        • Agarwalla A.
        • Puzzitiello R.N.
        • Sumner S.
        • Romeo A.A.
        • Mascarenhas R.
        The timing of injections prior to arthroscopic rotator cuff repair impacts the risk of surgical site infection.
        J Bone Joint Surg Am. 2019; 101: 682-687
        • Richardson S.S.
        • Schairer W.W.
        • Sculco T.P.
        • Sculco P.K.
        Comparison of infection risk with corticosteroid or hyaluronic acid injection prior to total knee arthroplasty.
        J Bone Joint Surg Am. 2019; 101: 112-118
        • Bedard N.A.
        • DeMik D.E.
        • Glass N.A.
        • Burnett R.A.
        • Bozic K.J.
        • Callaghan J.J.
        Impact of clinical practice guidelines on use of intra-articular hyaluronic acid and corticosteroid injections for knee osteoarthritis.
        J Bone Joint Surg Am. 2018; 100: 827-834
        • Basques B.A.
        • Gardner E.C.
        • Varthi A.G.
        • et al.
        Risk factors for short-term adverse events and readmission after arthroscopic meniscectomy: Does age matter?.
        Am J Sports Med. 2015; 43: 169-175
        • Rasmussen S.
        • Larsen A.S.
        • Thomsen S.T.
        • Kehlet H.
        Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and convalescence after arthroscopic meniscectomy.
        Pain. 1998; 78: 131-134
        • Agarwalla A.
        • Puzzitiello R.N.
        • Mascarenhas R.
        • Sumner S.
        • Romeo A.A.
        • Forsythe B.
        Preoperative injections may be an iatrogenic cause of reoperation after arthroscopic rotator cuff repair.
        Arthroscopy. 2019; 35: 325-331
        • Huebner K.D.
        • Shrive N.G.
        • Frank C.B.
        Dexamethasone inhibits inflammation and cartilage damage in a new model of post-traumatic osteoarthritis.
        J Orthop Res. 2014; 32: 566-572
        • Werner B.C.
        • Cancienne J.M.
        • Burrus M.T.
        • Griffin J.W.
        • Gwathmey F.W.
        • Brockmeier S.F.
        The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in Medicare patients.
        J Shoulder Elbow Surg. 2016; 25: 390-397
        • Wang D.
        • Camp C.L.
        • Ranawat A.S.
        • Coleman S.H.
        • Kelly B.T.
        • Werner B.C.
        The timing of hip arthroscopy after intra-articular hip injection affects postoperative infection risk.
        Arthroscopy. 2017; 33: 1988-1994.e1
        • Chambers A.W.
        • Lacy K.W.
        • Liow M.H.L.
        • Manalo J.P.M.
        • Freiberg A.A.
        • Kwon Y.M.
        Multiple hip intra-articular steroid injections increase risk of periprosthetic joint infection compared with single injections.
        J Arthroplasty. 2017; 32: 1980-1983
        • Schairer W.W.
        • Nwachukwu B.U.
        • Mayman D.J.
        • Lyman S.
        • Jerabek S.A.
        Preoperative hip injections increase the rate of periprosthetic infection after total hip arthroplasty.
        J Arthroplasty. 2016; 31 (suppl): 166-169.e1
        • Werner B.C.
        • Cancienne J.M.
        • Browne J.A.
        The timing of total hip arthroplasty after intraarticular hip injection affects postoperative infection risk.
        J Arthroplasty. 2016; 31: 820-823
        • Mills E.S.
        • Elman M.B.
        • Foran J.R.H.
        The risk of acute infection following intra-articular corticosteroid injection into a pre-existing total knee arthroplasty.
        J Arthroplasty. 2018; 33: 216-219
        • Camp C.L.
        • Cancienne J.M.
        • Degen R.M.
        • Dines J.S.
        • Altchek D.W.
        • Werner B.C.
        Factors that increase the risk of infection after elbow arthroscopy: Analysis of patient demographics, medical comorbidities, and steroid injections in 2,704 Medicare patients.
        Arthroscopy. 2017; 33: 1175-1179
        • McGarry J.G.
        • Daruwalla Z.J.
        The efficacy, accuracy and complications of corticosteroid injections of the knee joint.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1649-1654
        • Cancienne J.M.
        • Mahon H.S.
        • Dempsey I.J.
        • Miller M.D.
        • Werner B.C.
        Patient-related risk factors for infection following knee arthroscopy: An analysis of over 700,000 patients from two large databases.
        Knee. 2017; 24: 594-600
        • Balato G.
        • Di Donato S.L.
        • Ascione T.
        • et al.
        Knee septic arthritis after arthroscopy: Incidence, risk factors, functional outcome, and infection eradication rate.
        Joints. 2017; 5: 107-113