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Baksh N, Etcheson JI, Liu S, Ikwuazom CP, Chen Z, Dubin JA, Hameed D, Naziri Q. Pre-operative corticosteroid injection within 1 month of total shoulder arthroplasty is associated with increased risk of periprosthetic joint infection. Arch Orthop Trauma Surg 2023; 143:5609-5614. [PMID: 37058158 DOI: 10.1007/s00402-023-04866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Corticosteroid injections (CSI) may increase the risk of peri-prosthetic infections (PJI) following total shoulder arthroplasty (TSA). Our study specifically assessed the risk of PJI in patients who received CSI: (1) less than 4 weeks prior to TSA; (2) 4-8 weeks prior to TSA; and (3) 8-12 weeks prior to TSA. MATERIALS AND METHODS A national all-payer database was queried to identify patients who underwent TSA with a shoulder osteoarthritis diagnosis from October 1, 2015 to October 31, 2020 (n = 25,422). There were four cohorts: CSI within 4 weeks of TSA (n = 214), CSI 4-8 weeks prior to TSA (n = 473), CSI 8-12 weeks prior to TSA (n = 604), and a control cohort that did not receive CSI (n = 15,486). Bivariate chi-square analyses of outcomes were performed in addition to multivariate regression. RESULTS A significant increase in PJI risk at 1 year (Odds Ratio [OR] = 2.29, 95% Confidence Interval [CI] = 1.19-3.99, p = 0.007) and 2 years (OR = 2.03, CI = 1.09-3.46, p = 0.016) in patients who received CSI within 1 month of TSA was noted. PJI risk was not significantly increased at any time point for patients who received a CSI greater than 4 weeks prior to TSA (all p ≥ 0.396). CONCLUSION PJI risk is increased at both 1 and 2 years post-operatively in patients who received a CSI within 4 weeks of TSA. Therefore, TSA should be deferred at least 4 weeks after a patient receives a CSI to mitigate PJI risk. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nayeem Baksh
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Jennifer I Etcheson
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Scott Liu
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Chibuokem P Ikwuazom
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA.
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