Aamer Sonia, Tokhi Ilham, Asim Maaz, Akhtar Muzammil, Razick Daniel I, Wen Jimmy, Shelton Trevor J
Orthopedic Surgery, California Northstate University College of Medicine, Elk Grove, USA.
Surgery, California Northstate University College of Medicine, Elk Grove, USA.
Cureus. 2024 Jun 4;16(6):e61649. doi: 10.7759/cureus.61649. eCollection 2024 Jun.
Intra-articular injections prior to hip arthroscopy are often used to diagnose and conservatively manage hip pathologies, such as femoroacetabular impingement, labral tears, and chondral lesions. As a diagnostic tool, the relief of hip pain following an intra-articular injection helps pinpoint the primary source of pain and assists surgeons in recommending arthroscopic intervention for underlying intra-articular pathologies. However, when injections are not sufficiently spaced apart in time prior to hip arthroscopy, there is an elevated risk of postoperative infection. This systematic review aims to assess whether preoperative intra-articular injections prior to hip arthroscopy are associated with an increased risk of postoperative infection and to determine the safety timeframe for administering such injections prior to the procedure. A comprehensive search was conducted in the PubMed, Embase, and Cochrane Library databases to identify studies examining the relationship between preoperative intra-articular injections and postoperative infection following hip arthroscopy. A meta-analysis was conducted to compare the risk of infection between patients who received injections prior to hip arthroscopy at varying intervals and those who did not receive any preoperative injections. Five studies were included (four level III and one level IV), which consisted of 58,576 patients (58.4% female). Injections administered anytime prior to hip arthroscopy posed a significantly higher risk of infection compared to no history of prior injections (risk ratio: 1.45, 95% confidence interval: 1.14-1.85, P = 0.003). However, upon subanalysis, the risk of infection was significantly higher among patients who received injections within three months prior to hip arthroscopy compared to those who did not receive injections (risk ratio: 1.55, 95% confidence interval: 1.19-2.01, P = 0.001). Additionally, no significant difference in infection risk was observed when injections were administered more than three months before hip arthroscopy compared to no injections (risk ratio: 1.05, 95% confidence interval: 0.56-1.99, P = 0.87). The findings suggest that patients undergoing hip arthroscopy who have previously received intra-articular injections may face a statistically higher risk of postoperative infection, particularly when the injection is administered within three months prior to hip arthroscopy. Consequently, surgeons should exercise caution and avoid administering intra-articular injections to patients scheduled for hip arthroscopy within the subsequent three months to mitigate the increased risk of infection.
髋关节镜检查前的关节内注射常用于诊断和保守治疗髋关节疾病，如股骨髋臼撞击症、盂唇撕裂和软骨损伤。作为一种诊断工具，关节内注射后髋关节疼痛的缓解有助于确定疼痛的主要来源，并协助外科医生推荐针对潜在关节内病变的关节镜干预措施。然而，当在髋关节镜检查前注射时间间隔不足时，术后感染风险会升高。本系统评价旨在评估髋关节镜检查前的术前关节内注射是否与术后感染风险增加相关，并确定在手术前进行此类注射的安全时间范围。在PubMed、Embase和Cochrane图书馆数据库中进行了全面检索，以识别研究髋关节镜检查前术前关节内注射与术后感染之间关系的研究。进行了一项荟萃分析，以比较在不同时间间隔接受髋关节镜检查前注射的患者与未接受任何术前注射的患者之间的感染风险。纳入了五项研究（四项III级和一项IV级），共58576例患者（58.4%为女性）。与没有既往注射史相比，在髋关节镜检查前任何时间进行注射的感染风险显著更高（风险比：1.45，95%置信区间：1.14 - 1.85，P = 0.003）。然而，亚组分析显示，与未接受注射的患者相比，在髋关节镜检查前三个月内接受注射的患者感染风险显著更高（风险比：1.55，95%置信区间：1.19 - 2.01，P = 0.001）。此外，与未注射相比，在髋关节镜检查前三个月以上进行注射时，未观察到感染风险有显著差异（风险比：1.05，95%置信区间：0.56 - 1.99，P = 0.87）。研究结果表明，先前接受过关节内注射的髋关节镜检查患者术后感染的统计学风险可能更高，尤其是在髋关节镜检查前三个月内进行注射时。因此，外科医生应谨慎行事，避免在随后三个月内为计划进行髋关节镜检查的患者进行关节内注射，以降低感染风险增加的情况。
