Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA.
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Bone Joint J. 2022 May;104-B(5):620-626. doi: 10.1302/0301-620X.104B5.BJJ-2021-0024.R3.
Corticosteroid injections are often used to manage glenohumeral arthritis in patients who may be candidates for future total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (rTSA). In the conservative management of these patients, corticosteroid injections are often provided for symptomatic relief. The purpose of this study was to determine if the timing of corticosteroid injections prior to TSA or rTSA is associated with changes in rates of revision and periprosthetic joint infection (PJI) following these procedures.
Data were collected from a national insurance database from January 2006 to December 2017. Patients who underwent shoulder corticosteroid injection within one year prior to ipsilateral TSA or rTSA were identified and stratified into the following cohorts: < three months, three to six months, six to nine months, and nine to 12 months from time of corticosteroid injection to TSA or rTSA. A control cohort with no corticosteroid injection within one year prior to TSA or rTSA was used for comparison. Univariate and multivariate analyses were conducted to determine the association between specific time intervals and outcomes.
In total, 4,252 patients were included in this study. Among those, 1,632 patients (38.4%) received corticosteroid injection(s) within one year prior to TSA or rTSA and 2,620 patients (61.6%) did not. On multivariate analysis, patients who received corticosteroid injection < three months prior to TSA or rTSA were at significantly increased risk for revision (odds ratio (OR) 2.61 (95% confidence interval (CI) 1.77 to 3.28); p < 0.001) when compared with the control cohort. However, there was no significant increase in revision risk for all other timing interval cohorts. Notably, Charlson Comorbidity Index ≥ 3 was a significant independent risk factor for all-cause revision (OR 4.00 (95% CI 1.40 to 8.92); p = 0.036).
There is a time-dependent relationship between the preoperative timing of corticosteroid injection and the incidence of all-cause revision surgery following TSA or rTSA. This analysis suggests that an interval of at least three months should be maintained between corticosteroid injection and TSA or rTSA to minimize risks of subsequent revision surgery. Cite this article: 2022;104-B(5):620-626.
皮质类固醇注射常用于管理可能成为全肩关节置换术（TSA）或反式肩关节置换术（rTSA）候选者的肩关节炎患者。在这些患者的保守治疗中，常提供皮质类固醇注射以缓解症状。本研究的目的是确定在 TSA 或 rTSA 之前进行皮质类固醇注射的时间与这些手术后翻修率和假体周围关节感染（PJI）的变化是否相关。
数据来自 2006 年 1 月至 2017 年 12 月的全国性保险数据库。确定了在同侧 TSA 或 rTSA 前一年内接受肩部皮质类固醇注射的患者，并将其分为以下队列：皮质类固醇注射后至 TSA 或 rTSA 的时间<三个月、三至六个月、六至九个月和九至十二个月。使用 TSA 或 rTSA 前一年内未接受皮质类固醇注射的对照组进行比较。进行单变量和多变量分析以确定特定时间间隔与结果之间的关联。
共有 4252 名患者纳入本研究。其中，1632 名患者（38.4%）在 TSA 或 rTSA 前一年内接受了皮质类固醇注射，2620 名患者（61.6%）未接受皮质类固醇注射。多变量分析显示，与对照组相比，在 TSA 或 rTSA 前三个月内接受皮质类固醇注射的患者翻修风险显著增加（比值比（OR）2.61（95%置信区间（CI）1.77 至 3.28）；p<0.001）。然而，所有其他时间间隔队列的翻修风险均无显著增加。值得注意的是，Charlson 合并症指数≥3 是全因翻修的显著独立危险因素（OR 4.00（95%CI 1.40 至 8.92）；p=0.036）。
皮质类固醇注射的术前时间与 TSA 或 rTSA 后全因翻修手术的发生率之间存在时间依赖性关系。本分析表明，在皮质类固醇注射和 TSA 或 rTSA 之间应至少保持三个月的间隔，以最大程度地降低随后翻修手术的风险。
2022;104-B(5):620-626.
