Aims

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).

Aim. The purpose of the study was to assess the safety of Intra-articular steroid hip injections (IASHI), prior to ipsilateral total hip arthroplasty (THA). Method. We investigated whether there was an excess of infection in such a group 7–10 years after total hip arthroplasty. A database of 49 patients who had undergone IASHI followed by ipsilateral THA was reviewed. Results. The mean length of time between injection and arthroplasty was 12.1 months (5.1–19 months). We found 7 major complications. Ten patients died with no further hip surgery at a mean of 28 months from surgery; 3 were lost to follow-up. The remaining group (36) were contacted by telephone at a mean of 97.8 (85–117) months from their surgery. No objective signs of joint infection were found. Conclusion. We believe our results show that ipsilateral steroid injection does not confer an increased risk of complications following subsequent THA, over an extended follow up

Introduction and Aims: Intra-articular steroid hip injection (IASHI) for osteoarthritis of the hip has not been well studied. The immunosuppressive nature of steroids may be hypothesised to interfere with asepsis in subsequent total hip arthroplasty (THA). We evaluate the infectious complications and functional outcomes of THA performed in patients who previously received IASHI. Method: This is a retrospective cohort study of functional outcomes (Harris and Oxford hip scores), and infectious complications in the first year following THA, in patients without (n=40 controls) or with (n=40) a history of ipsilateral IASHI. Functional scores had been compiled in our database, at one tertiary care centre, and infectious complications (wound infection, deep infection, work-up with bone scans, revision surgery) were retrospectively reviewed from hospital records. Results: The IASHI group had worse post-THA function (p=0.0008 ANOVA for Oxford functional hip scores across time, with mean one-year scores being worse by seven points out of 60). In the IASHI group there were five revision surgeries, four of which were for deep infection of the hip replacement (10%, versus 0% in controls, versus 1.02% in our database of 979 THA primaries, p < 0.001 by Log-Rank testing of Kaplan-Meier survivor-ship analysis). Additionally, each group had two superficial wound infections. Six additional IASHI patients underwent infectious work-ups for ongoing hip problems (compared to one patient worked-up in the control group). The total rate of culture-proven infection (either superficial or deep), or problems leading to negative infectious work-up, was 12/40 (steroid, 30%) versus 3/40 (control, 7.5%, p = 0.010 by Fisher’s Exact test). Conclusion: IASHI should now be considered as relatively contra-indicated in patients who are (or will become) candidates for THA. IASHI appears to compromise the functional results of subsequent THA, with much higher infection and revision rates. We suggest a multi-centre review of infected THA post-IASHI

Introduction and Aims: Intra-articular steroid hip injection (IASHI) has been extensively administered for painful hip arthritis since the 1950s, but with advances in medical and surgical management, its role is less certain today. There is very little published data on the utility or prescribing patterns of IASHI. Method: A questionnaire seeking expert opinions on IASHI was developed and distributed to practising Ontario-based members of the Canadian Orthopaedic Association. Initial phone calls identified those who perform hip replacements, and subsequent faxed forms had a 73% response rate (99 surgeons). We systematically describe the current practices and expert opinions of 99 hip surgeons, on the use of IASHI, focusing on indications, current usage, and complications. Results: Only 56% of surgeons felt that IASHI was actually useful therapeutically, though four in five surgeons cited the usefulness of hip injection for differentiating hip-spine co-morbidity in diagnostically challenging patients. Therapeutic benefit from IASHI was perceived to be poor, with 72% of surgeons estimating that between zero and 60% of their patients achieved any benefit at all from the injections, with duration of benefit uniformly estimated as being between zero and six months. Infection rates were considered to be less than 2% by most surgeons. One quarter of the surgeons felt that IASHI accelerates arthritis progression, most of whom had stated that it would be no great loss if IASHI was no longer available. Nineteen percent of the surgeons believed that there may be increased infection rate of THA after IASHI, and this was associated with lower numbers of IASHI ordered per year, compared to those who did not feel that infection rates would increase. The opinions of this large group of experts is consistent with efficacy studies, and forms a context for our ongoing studies of infected hip arthroplasty post-IASHI. Conclusion: Opinions were mixed, with substantial numbers of surgeons stating that the procedure is not therapeutically helpful, may accelerate arthritis progression, or may increase infections after subsequent total hip arthroplasty. This information provides a systematic collection of expert opinions, as well as a context for forthcoming studies on effectiveness and complications