Saba Braden V, Cardillo Casey, Haider Muhammad A, Schwarzkopf Ran, Davidovitch Roy I
Division of Adult Reconstructive Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2025 Aug;40(8S1):S124-S129. doi: 10.1016/j.arth.2025.03.045. Epub 2025 Mar 24.
Corticosteroid injections following total hip arthroplasty (THA) are commonly used to address soft tissue pathology such as bursitis and tendinitis. The THA surgical approaches differ in the extent of muscle and soft tissue dissection. The aim of this study was to compare the impact of surgical approach on postoperative corticosteroid injection requirements when controlling for multiple covariates. A secondary aim was to identify risk factors associated with the various injection types.
This was a propensity-matched retrospective study of 10,907 THA patients from June 2016 to December 2022 at a single urban academic health center. Patients were stratified into cohorts based on the following surgical approaches: anterior (n = 4,287) and posterior (n = 6,620), then propensity-matched 1:1 with nearest neighbor matching to form two cohorts of 4,287 patients. Baseline characteristics and corticosteroid injection data for soft-tissue pathology were obtained and analyzed. Chi-square and multivariate logistic regression analyses were used to assess the impact of patient and surgical factors on receiving postoperative steroid injections.
A posterior approach conferred increased risk of postoperative injections (adjusted odds ratio 1.242, P = 0.001) after controlling for multiple covariates. The posterior approach also had higher total rates of greater trochanter bursitis injections postoperatively compared to the anterior group (11.5 versus 7.3%, P < 0.001). Both surgical approaches demonstrated comparable rates of iliopsoas bursitis injections (P = 0.39), gluteus medius tendinosis injections (P = 0.09), and lateral femoral cutaneous nerve injections (P = 0.27). The strongest predictor of postoperative injections was a history of preoperative injection (adjusted odds ratio 3.772, P < 0.001).
Posterior approach, women, and history of preoperative corticosteroid injection were identified as the strongest risk factors for postoperative greater trochanter bursitis injection or postoperative soft tissue injection. These factors should be considered when counseling patients on expected postoperative outcomes and the likelihood of corticosteroid injections following THA.
全髋关节置换术（THA）后注射皮质类固醇常用于治疗滑囊炎和肌腱炎等软组织病变。THA的手术入路在肌肉和软组织解剖范围上有所不同。本研究的目的是在控制多个协变量的情况下，比较手术入路对术后皮质类固醇注射需求的影响。次要目的是确定与各种注射类型相关的危险因素。
这是一项对2016年6月至2022年12月在一家城市学术医疗中心的10907例THA患者进行的倾向匹配回顾性研究。患者根据以下手术入路分层为队列：前路（n = 4287）和后路（n = 6620），然后以1:1的比例与最近邻匹配进行倾向匹配，形成两个各有4287例患者的队列。获取并分析软组织病变的基线特征和皮质类固醇注射数据。采用卡方检验和多因素逻辑回归分析来评估患者和手术因素对接受术后类固醇注射的影响。
在控制多个协变量后，后路手术入路增加了术后注射的风险（调整后的优势比为1.242，P = 0.001）。与前路组相比，后路手术入路术后大转子滑囊炎注射的总发生率也更高（11.5%对7.3%，P < 0.001）。两种手术入路在髂腰肌滑囊炎注射率（P = 0.39）、臀中肌腱病注射率（P = 0.09）和股外侧皮神经注射率（P = 0.27）方面相当。术后注射的最强预测因素是术前注射史（调整后的优势比为3.772，P < 0.001）。
后路手术入路、女性以及术前皮质类固醇注射史被确定为术后大转子滑囊炎注射或术后软组织注射的最强危险因素。在向患者咨询THA术后预期结果和皮质类固醇注射可能性时，应考虑这些因素。
