Association Between Intraoperative Periarticular Injection of Triamcinolone and Early Postoperative Infection in Total Knee Arthroplasty: An Analysis of a Japanese Nationwide Database.

Abstract

The safety of intraoperative periarticular triamcinolone injection in total knee arthroplasty (TKA) remains unclear. This study aimed to assess the association between periarticular injection of triamcinolone during primary TKA and complications, including early postoperative infection. A Japanese nationwide database was used to identify adults who underwent primary TKA between April 2016 and March 2022. Patients were divided into triamcinolone and control groups. The primary outcome was reoperation for infection within 90 days from primary TKA. Secondary outcomes included diagnosis of postoperative infection, wound complications, deep vein thrombosis, pulmonary embolism, inhospital death, and readmission within 90 days. Propensity score matching was performed to adjust baseline differences. During the study period, 242,571 cases underwent primary knee arthroplasty. Among 212,427 eligible TKA patients, 15,229 (7.2%) were in the triamcinolone group and 197,198 (92.8%) were in the control group. Overall, there were 551 reoperations for infection within 90 days (0.26%), including 61 (0.40%) patients in the triamcinolone group and 490 (0.25%) in the control group. Propensity score matching yielded 14,683 pairs. The triamcinolone group had a higher incidence of reoperation for infection, with a risk ratio (RR) of 1.67 (95% confidence interval [CI]: 1.10 to 2.53) and risk difference of 0.16% (95% CI: 0.03 to 0.29). Diagnoses of infection (RR: 1.25 [95% CI: 1.09 to 1.44]) and wound complications (RR: 1.18 [95% CI: 0.99 to 1.39]) were more frequent in the triamcinolone group, while deep vein thrombosis incidence was significantly lower (RR: 0.69 [95% CI: 0.65 to 0.73]). No significant differences were observed in pulmonary embolism or inhospital death, although 90-day readmission was more frequent in the triamcinolone group (RR: 1.22 [95% CI: 1.06 to 1.40]). Although the difference was subtle, periarticular injection of triamcinolone during TKA was associated with an increased risk of early postoperative infection requiring reoperation.