Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Center for Hip Preservation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4088-4097. doi: 10.1007/s00167-022-06942-3. Epub 2022 Mar 24.
This systematic review and meta-analysis analyzed the influence of pre-operative intra-articular injections (IAI) on periprosthetic joint infection (PJI) rates after primary total knee arthroplasty (TKA).
Studies published between January 1st, 2000 and May 1st, 2021 evaluating PJI rates among TKA patients with and without IAI were identified from PubMed, Cochrane Library, MEDLINE, EBSCO Host, and Google Scholar. The pooled effect of IAI on PJI risk was calculated utilizing Mantel-Haenszel (M-H) models. Sub-analysis comparisons were conducted based on the interval from IAI to TKA: 0-3 months; > 3-6 months; > 6-12 months. The Methodological Index for Non-Randomized Studies (MINORS) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool were utilized to evaluate the quality of each included study.
The present analysis included 12 studies reporting on 349,605 TKAs (IAI: n = 115,122; No IAI: n = 234,483). Patients receiving an IAI at any point prior to TKA (2850/115,122; 2.48%) had statistically significant increased risk of infection compared to patients not receiving IAIs (4479/234,483; 1.91%; OR: 1.14, 95% CI: 1.08-1.20; p < 0.0001). However, this finding was not demonstrated across sensitivity analyses. Receiving injections within 3 months prior to TKA was associated with increased infection risk (OR: 1.23, 95% CI: 1.14-1.31; p < 0.0001). There were no differences in infection rates when injections were given between > 3 and 6 months (OR: 0.82, 95% CI: 0.47-1.43; p = 0.49) and > 6-12 months prior to TKA (OR: 1.26, 95% CI: 0.89-1.78; p = 0.18).
Based on the current literature, the findings of this analysis suggest that patients receiving IAI should wait at least 3 months before undergoing TKA to mitigate infection risk. Orthopaedic surgeons and patients can utilize this information when undergoing shared decision-making regarding osteoarthritis management options and timing.
Level III.
本系统评价和荟萃分析分析了初次全膝关节置换术（TKA）前关节内注射（IAI）对假体周围关节感染（PJI）发生率的影响。
从 PubMed、Cochrane 图书馆、MEDLINE、EBSCO 主机和 Google Scholar 中检索了 2000 年 1 月 1 日至 2021 年 5 月 1 日评估 TKA 患者接受 IAI 和未接受 IAI 时 PJI 发生率的研究。利用 Mantel-Haenszel（M-H）模型计算 IAI 对 PJI 风险的 pooled 效应。根据 IAI 到 TKA 的时间间隔进行亚组分析比较：0-3 个月；>3-6 个月；>6-12 个月。本研究使用非随机研究的方法学指数（MINORS）和非随机干预研究的偏倚风险（ROBINS-I）工具评估每个纳入研究的质量。
本分析包括 12 项研究，报告了 349605 例 TKA（IAI：n=115122；无 IAI：n=234483）。与未接受 IAIs 的患者相比，在 TKA 前任何时间点接受 IAI 的患者（2850/115122；2.48%）感染风险具有统计学意义的增加（4479/234483；1.91%；OR：1.14，95%CI：1.08-1.20；p<0.0001）。然而，这一发现并未在敏感性分析中得到证实。在 TKA 前 3 个月内接受注射与感染风险增加相关（OR：1.23，95%CI：1.14-1.31；p<0.0001）。当注射时间在 3-6 个月（OR：0.82，95%CI：0.47-1.43；p=0.49）和 6-12 个月（OR：1.26，95%CI：0.89-1.78；p=0.18）前时，感染率没有差异。
根据目前的文献，本分析的结果表明，接受 IAI 的患者应至少等待 3 个月后再进行 TKA，以降低感染风险。骨科医生和患者可以在共同决策关节炎管理方案和时间时利用这些信息。
III 级。
