Marsland Daniel, Mumith Aadil, Barlow Ian W
Department of Orthopaedic Surgery, Dorset County Hospital NHS Trust, Dorset, UK.
Department of Orthopaedic Surgery, Dorset County Hospital NHS Trust, Dorset, UK.
Knee. 2014 Jan;21(1):6-11. doi: 10.1016/j.knee.2013.07.003. Epub 2013 Aug 12.
Up to 30% of patients undergoing total knee arthroplasty (TKA) have received intra-articular corticosteroid injections prior to surgery. Debate exists as to whether such injections increase the rate of post-operative infection. Given that deep infection is a disastrous complication, a systematic review of the literature was undertaken to evaluate the safety of intra-articular corticosteroid injections given prior to TKA. Other features of corticosteroid use are also discussed including mechanism of action and optimal dosage.
Using PRISMA guidelines, EMBASE, CINAHL and MEDLINE databases were searched using the search terms 'total knee arthroplasty', 'replacement', 'corticosteroid', 'steroid', 'infection', 'safety', and relevant articles critically appraised. The Newcastle-Ottawa Scale was used to assess for bias.
No level one or two studies were available for review. Two retrospective case control studies and two cohort studies (level three evidence) which specifically evaluated the risk of infected TKA in association with pre-operative steroid injection were reviewed: three showed that prior steroid injection was not associated with increased infection rates; one article showed that prior steroid injection was associated with a significantly increased risk of deep infection post-TKA.
Clinicians commonly administer steroid injections to patients who are candidates for TKA but may be unaware of the potential long term complications. The included studies were underpowered and at risk of selection bias and only one study demonstrated an increased risk of infection post-operatively. We recommend that further research is required to evaluate the safety of steroid injection prior to TKA.
III.
接受全膝关节置换术（TKA）的患者中，高达30%在手术前接受过关节内皮质类固醇注射。对于此类注射是否会增加术后感染率存在争议。鉴于深部感染是一种灾难性并发症，因此对文献进行了系统综述，以评估TKA术前关节内皮质类固醇注射的安全性。还讨论了皮质类固醇使用的其他特征，包括作用机制和最佳剂量。
按照PRISMA指南，使用搜索词“全膝关节置换术”、“置换”、“皮质类固醇”、“类固醇”、“感染”、“安全性”检索EMBASE、CINAHL和MEDLINE数据库，并对相关文章进行严格评价。使用纽卡斯尔-渥太华量表评估偏倚。
没有一级或二级研究可供综述。对两项回顾性病例对照研究和两项队列研究（三级证据）进行了综述，这些研究专门评估了术前注射类固醇与感染性TKA风险的相关性：三项研究表明，术前注射类固醇与感染率增加无关；一篇文章表明，术前注射类固醇与TKA术后深部感染风险显著增加有关。
临床医生通常会给TKA候选患者注射类固醇，但可能未意识到潜在的长期并发症。纳入的研究样本量不足且存在选择偏倚风险，只有一项研究表明术后感染风险增加。我们建议需要进一步研究来评估TKA术前类固醇注射的安全性。
III级。
