Bergman Clinics, Department of Orthopaedic Surgery, Klein Rosendael, Amsterdam, the Netherlands.
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
J Arthroplasty. 2021 Mar;36(3):1003-1008. doi: 10.1016/j.arth.2020.09.024. Epub 2020 Sep 21.
Intra-articular hyaluronic acid (IAHA) can be injected into an osteoarthritic hip joint to reduce pain and to improve functionality. Several studies report IAHA to be safe, with minor adverse effects that normally disappear spontaneously within a week. However, intra-articular corticosteroids prior to total hip arthroplasty (THA) have been associated with increased infection rates. This association has never been investigated for IAHA and THA. We aimed to assess the influence of IAHA on the outcome of THA, with an emphasis on periprosthetic joint infection (PJI).
At a mean follow-up of 52 months (±18), we compared complication rates, including superficial and deep PJIs, of THA in patients who received an IAHA injection ≤6 months prior to surgery (injection group) with that of patients undergoing THA without any previous injection in the ipsilateral hip (control group). One hundred thirteen patients (118 hips) could be retrospectively included in the injection group, and 452 patients (495 hips) in the control group.
No differences in baseline characteristics nor risk factors for PJI between the 2 groups were found. The clinical outcomes in terms of VAS pain scores (1.4 vs 1.7 points, P = .11), modified Harris Hip Scores (77 vs 75 points, P = .09), and Hip disability and Osteoarthritis Outcome Scores (79 vs 76 points, P = .24) did not differ between the injection group and the control group. Also, complications in terms of persistent wound leakage (0% vs 1.2%, P = .60), thromboembolic events (0% vs 0.6%, P = 1.00), periprosthetic fractures (1.7% vs 1.2%, P = .65), and dislocations (0% vs 0.4%, P = 1.00) did not differ. However, in the injection group there was a higher rate of PJIs (4% vs 0%, P < .001) and postoperative wound infections (9% vs 3%, P = .01), compared to the control group.
Our findings suggest that IAHA performed 6 months or less prior to THA may pose a risk for increased rates of PJI. We recommend refraining from performing THA within 6 months after IAHA administration.
关节内透明质酸（IAHA）可注射到骨关节炎髋关节以减轻疼痛并改善功能。几项研究报告 IAHA 是安全的，只有轻微的不良反应，通常在一周内自发消失。然而，在全髋关节置换术（THA）之前关节内皮质类固醇与感染率增加有关。这种关联从未在 IAHA 和 THA 中进行过研究。我们旨在评估 IAHA 对 THA 结果的影响，重点是假体周围关节感染（PJI）。
在平均 52 个月（±18）的随访中，我们比较了接受手术前≤6 个月 IAHA 注射的患者（注射组）与同侧髋关节无任何先前注射的患者（对照组）THA 的并发症发生率，包括浅表和深部 PJI。113 例患者（118 髋）可回顾性纳入注射组，452 例患者（495 髋）纳入对照组。
两组间基线特征和 PJI 的危险因素均无差异。在 VAS 疼痛评分（1.4 与 1.7 分，P=0.11）、改良 Harris 髋关节评分（77 与 75 分，P=0.09）和髋关节残疾和骨关节炎结果评分（79 与 76 分，P=0.24）方面，注射组和对照组之间的临床结果无差异。此外，在持续伤口漏液（0%与 1.2%，P=0.60）、血栓栓塞事件（0%与 0.6%，P=1.00）、假体周围骨折（1.7%与 1.2%，P=0.65）和脱位（0%与 0.4%，P=1.00）方面，两组之间也没有差异。然而，与对照组相比，注射组的 PJI 发生率（4%与 0%，P<0.001）和术后伤口感染率（9%与 3%，P=0.01）更高。
我们的研究结果表明，THA 前 6 个月或更短时间内进行 IAHA 可能会增加 PJI 的发生率。我们建议在 IAHA 给药后 6 个月内避免进行 THA。
