Pre-operative corticosteroid injection within 1 month of total shoulder arthroplasty is associated with increased risk of periprosthetic joint infection

Apr 14, 2023Archives of orthopaedic and trauma surgery

Corticosteroid injections within 1 month before shoulder replacement may increase infection risk around the implant

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Abstract

Patients receiving corticosteroid injections within 4 weeks prior to total shoulder arthroplasty have an increased risk of peri-prosthetic infections at 1 and 2 years post-surgery.

The risk of peri-prosthetic infections at 1 year is significantly increased with an Odds Ratio of 2.29 for those receiving injections within 4 weeks.
At 2 years, the risk remains elevated with an Odds Ratio of 2.03 for the same group.
Patients who received corticosteroid injections more than 4 weeks prior to surgery did not show a significant increase in infection risk.
The findings suggest that delaying total shoulder arthroplasty for at least 4 weeks after corticosteroid injections may help reduce infection risk.

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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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Pre-operative corticosteroid injection within 1 month of total shoulder arthroplasty is associated with increased risk of periprosthetic joint infection

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