gms | German Medical Science

Objectives: Intra-articular corticosteroid injections (ICSI) are an effective symptomatic treatment for osteoarthritis of the hip. However, the safety of ICSI has been questioned and a relatively high risk for septic arthritis, rapidly progressive osteoarthritis (RPIO) and periprosthetic joint infections (PJI) in patients undergoing subsequent total hip arthroplasty (THA) have been suggested.

Methods: This is a retrospective evaluation of 682 hips that underwent ICSI with 40mg of Triamcinolone acetonide, 40mg Lidocaine and 1mg Marcaine for primary osteoarthritis of the hip. All ICSI were performed using sterile techniques, the number of ICSI in each hip and the cumulative corticosteroid dosage were assessed. Pre- and post-injection radiographs were compared to identify cases with RPIO and determine the grade of osteoarthritis prior to injection (Kellgren-Lawrence score). Cases with native joint septic arthritis, surgical site infections and PJI following arthroplasty implantation were identified by chart review.

Results and conclusion: The mean number of ICSI to the hip was 1.9 (range 1–9, SD 1.6), the mean cumulative Triamcinolone dose was 75mg (range 40–360 mg, SD 62 mg). The mean time between the first and last ICSI was 19 months (range 0–118 months, SD 21). 4 hips (0.6%) developed RPIO 2-4 months following ICSI. The stage of Osteoarthritis at the time of injection in these cases was Kellgren-Lawrence grade 1 in 1 case, grade 2 in 1 case, and grade 3 in 2 cases.Time between ICSI and diagnosis of RPIO was 2-4 months, all underwent THA within 3-5 months following ICSI. There was no association between the cumulative Triamcinolone dose and the onset of RPIO (p=0.281). 1 case was diagnosed with septic arthritis and successfully treated with staged THA. 483 hips (75.7%) underwent THA, including 199 hips with THA less than 3 months following ICSI and 181 hips with >1 ICSI prior to THA. There were 3 superficial surgical site infections/wound dehiscence and no PJI.

The current findings suggest that if ICSI is performed under sterile conditions, the risk for septic arthritis or PJI following THA, even in patients with multiple ICSI or ICSI within 3 months prior to surgery, is minimal.