Lucenti Ludovico, Panvini Flora Maria Chiara, de Cristo Claudia, Rapisarda Damiano, Sapienza Marco, Testa Gianluca, Pavone Vito
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy.
Healthcare (Basel). 2024 Feb 24;12(5):543. doi: 10.3390/healthcare12050543.
Corticosteroid injections have demonstrated short-term benefits for shoulder pain. This symptomatic treatment method is used in various inflammatory conditions that affect the shoulder joint. Corticosteroid joint injections are not without risks and complications. Adverse effects have been documented, including damage to the articular cartilage, tendon rupture, and attenuation of the subject's immune response. The aim of this study was to examine the timing of preoperative corticosteroid injections on infectious outcomes of shoulder arthroscopies and shoulder arthroplasty.
In accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the PubMed, Cochrane, and Science Direct databases were systematically reviewed by two independent authors in January 2024. After full-text reading and checking the reference lists, 11 article were included.
Patients who received a shoulder injection within three months prior to undergoing shoulder arthroplasty exhibited a markedly elevated incidence of infection. In addition, a significantly increased risk of periprosthetic joint infection (PJI) at 90 days postoperatively in patients who received CSIs (corticosteroid injections) within 1 month prior to shoulder arthroplasty was found. Different authors consider CSI injections within the 2 weeks prior to shoulder arthroscopy surgery principally associated with an increased risk of postoperative infection.
There is still no consensus on the correct timing of preoperative CSIs in both arthroscopic and arthroplasty procedures. The literature does not identify whether the number of preoperative injections could increase the risk of periprosthetic infection. Obesity, sex, and smoking did not have a significant effect on PJIs; alcohol abuse could be considered as a risk factor for PJIs with CSIs. Both in prosthetic surgeries and in arthroscopy procedures, modifiable and unmodifiable factors play secondary roles. The risk of postoperative infection is greater within 3 months, although it is almost comparable at one- and two-year follow-ups.
皮质类固醇注射已被证明对肩部疼痛有短期益处。这种对症治疗方法用于各种影响肩关节的炎症性疾病。皮质类固醇关节注射并非没有风险和并发症。已记录到不良反应，包括关节软骨损伤、肌腱断裂和受试者免疫反应减弱。本研究的目的是检查术前皮质类固醇注射时间对肩关节镜检查和肩关节置换术感染结果的影响。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，2024年1月由两名独立作者对PubMed、Cochrane和Science Direct数据库进行了系统评价。在全文阅读并检查参考文献列表后，纳入了11篇文章。
在接受肩关节置换术前三 个月内接受肩部注射的患者感染发生率明显升高。此外，发现在肩关节置换术前1个月内接受皮质类固醇注射（CSI）的患者术后90天假体周围关节感染（PJI）风险显著增加。不同作者认为在肩关节镜手术前2周内进行CSI注射主要与术后感染风险增加有关。
在关节镜和置换手术中，术前CSI的正确时间仍未达成共识。文献未确定术前注射次数是否会增加假体周围感染的风险。肥胖、性别和吸烟对PJI没有显著影响；酗酒可被视为CSI导致PJI的一个风险因素。在假体手术和关节镜手术中，可改变和不可改变的因素都起次要作用。术后3个月内感染风险更大，尽管在1年和2年随访时几乎相当。
