Does a Simple Needle Stick From a Preoperative Knee Aspiration or Non-Steroidal Injection Influence Total Knee Arthroplasty Infection Risk? A Retrospective Database Analysis.

Abstract

Intra-articular injections (IAIs) of corticosteroids administered within 6 months before total knee arthroplasty (TKA) have been linked to an increased risk of post-TKA infection. The local immunosuppressive response to undissolved corticosteroids and disruption of the joint's physical barrier are proposed mechanisms to augment the risk of infection. However, it remains unclear whether simple aspirations with or without non-corticosteroid injection medications pose similar risks. This study explored the association between the timing of non-corticosteroid IAIs administered before TKA and the increased risk of infection. A national claims database containing > 42 million inpatient records was queried to retrieve TKA claims between 2017 and 2022. Patient records were examined during the perioperative period for IAI treatments. These include platelet-rich plasma, stem cell therapy, ketorolac, and simple aspiration without corticosteroids. Patient records were stratified based on the timing of the most recent injection, distinguishing between 6-, 3-, and 1-month intervals. The primary outcome assessed was the incidence and risk of infections necessitating surgical debridement within 1 year of the index TKA procedure. A total of 232,342 patient records were retrieved, of which 8,019 (3.5%) patients received prior IAI within 6 months of TKA. The rate of infection requiring surgical debridement was the highest in patients receiving aspiration/injection within 1 month of their index (7.6%), followed by those receiving IAI within three (4.6%) and 6 months (2.2%), with the lowest incidence in those who had not received injections within 6 months (1.4%). Even when immunosuppressive medications, such as corticosteroids, are removed, the odds of infection remain high in patients receiving IAIs/aspiration before TKA, particularly when administered within 3 months of the procedure. Therefore, surgeons should consider postponing surgery for up to 3 months, regardless of the content of IAIs. III.