Effect of Preoperative Corticosteroid Injections on Postoperative Risk of Periprosthetic Joint Infection and Revision Surgery After Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis.

In total joint arthroplasty, periprosthetic joint infection (PJI) can be devastating. Corticosteroid injections (CSIs) are commonly administered for temporary pain relief in the setting of various conditions. Therefore, the current systematic review aims to evaluate whether CSIs administered prior to total shoulder arthroplasty (TSA) are a risk factor for PJI and revision surgery. A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Scopus databases to identify studies evaluating outcomes in patients receiving CSIs prior to TSA. A meta-analysis comparing the risk of PJI between patients receiving CSIs at various time points versus those with no CSIs was performed. Seven studies comprising 49,786 patients who received CSIs were included. Most studies reported significantly higher odds of PJI and revision surgery when CSIs were administered within three months of TSA. The results of the meta-analysis found the risk of PJI was significantly higher when CSIs were administered within three months of TSA (risk ratio (RR): 1.12, 95% confidence interval (CI): 1.04-1.20, P = 0.002) but not greater than three months prior to TSA (RR: 1.02, 95% CI: 0.80-1.30, P = 0.85), relative to a control group undergoing TSA with no prior CSIs. Several studies have demonstrated that CSIs are associated with increased risks of PJI and revision surgery. A safe interval between CSI and subsequent TSA, to minimize the risk of PJI and revision surgery, appears to be around one to three months, with three months being the safest time period, as supported by the findings of our meta-analysis.