From the Pritzker School of Medicine at The University of Chicago (Bhattacharjee), the Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago (Wallace, Luu, Shi, and Lee), Chicago, IL, and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Chen).
J Am Acad Orthop Surg. 2021 Jul 15;29(14):e714-e721. doi: 10.5435/JAAOS-D-20-00850.
Corticosteroid injections administered within 3 months before total knee arthroplasty (TKA) have been linked to increased risk of postoperative infection. However, it would be beneficial to further delineate the timing of injections to determine whether a narrower window exists for safe administration of corticosteroid injections. The purposes of our study were to (1) determine whether there were a different time frame between corticosteroid injection and primary TKA that increased infection risk and (2) determine risk factors associated with infection after TKA.
TKA patients were identified from a national database from 2007 to 2017 and stratified based on their history of corticosteroid injections within the 6-month preoperative period. Patients who received injections were stratified into biweekly cohorts by the timing of their most recent injection. The 1-year rate of postoperative infection treated by surgical débridement was compared between injection and noninjection cohorts. Univariate logistic regressions of risk factors and a multivariate analysis for patient comorbidities and injection cohorts associated with increased infection risk were conducted.
In the 76,090 TKA patients identified, corticosteroid injection within 2 weeks before TKA increased the risk of postoperative infection (P = 0.02) and injections within 2 to 4 weeks trended toward increased infection in univariate regression. No significant differences were observed in any other injection time frames. In the multivariate analysis, injections within 2 weeks before TKA were identified as an independent risk factor (odds ratio: 2.89; P = 0.04) for postoperative infection. Additional risk factors included chronic obstructive pulmonary disease, coronary artery disease, diabetes, ischemic heart disease, obesity, rheumatoid arthritis, and tobacco, whereas female sex and patient aged older than 65 were protective.
Our results suggest that TKA performed within four weeks of a corticosteroid injection may be associated with a higher risk of postoperative infection; however, delaying surgery more than four weeks may not provide additional infection risk reduction. Further prospective randomized studies are needed to determine the optimal timing of TKA after corticosteroid injections.
Level III.
在全膝关节置换术（TKA）前 3 个月内给予皮质类固醇注射与术后感染风险增加有关。然而，进一步详细说明注射的时间安排将有助于确定是否存在更窄的安全给药窗口。本研究的目的是：（1）确定皮质类固醇注射与初次 TKA 之间是否存在不同的时间框架，从而增加感染风险；（2）确定 TKA 后感染的相关危险因素。
从 2007 年至 2017 年的国家数据库中确定 TKA 患者，并根据他们在术前 6 个月内皮质类固醇注射史进行分层。将接受注射的患者根据最近一次注射的时间分为两周一次的队列。比较注射组和非注射组术后 1 年接受手术清创治疗的感染发生率。对危险因素进行单变量逻辑回归，并对与感染风险增加相关的患者合并症和注射队列进行多变量分析。
在确定的 76090 例 TKA 患者中，TKA 前 2 周内注射皮质类固醇增加了术后感染的风险（P=0.02），且在单变量回归中，2 至 4 周内注射皮质类固醇感染风险呈上升趋势。在其他任何注射时间框架内均未观察到显著差异。在多变量分析中，TKA 前 2 周内注射被确定为术后感染的独立危险因素（比值比：2.89；P=0.04）。其他危险因素包括慢性阻塞性肺疾病、冠状动脉疾病、糖尿病、缺血性心脏病、肥胖、类风湿关节炎和吸烟，而女性和 65 岁以上患者则具有保护作用。
我们的结果表明，TKA 在皮质类固醇注射后四周内进行可能与术后感染风险增加相关；然而，将手术推迟超过四周可能不会降低额外的感染风险。需要进一步进行前瞻性随机研究，以确定皮质类固醇注射后 TKA 的最佳时机。
三级。
