title: Preoperative Hip Injections Increase the Rate of Periprosthetic Infection After Total Hip Arthroplasty.
abstract: Intraarticular injections are both diagnostic and therapeutic for patients with osteoarthritis. A potential risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) may occur from direct inoculation and/or immune suppression by corticosteroids. Large population-level databases were used to evaluate hip injection on the 1-year rate of PJI in patients undergoing primary THA.
  
  
  
  State-level ambulatory surgery and inpatient databases for Florida and California (2005-2012) were used to identify primary THA patients with 1-year preoperative and postoperative windows to evaluate possible injections or PJI, respectively. Patients were grouped as no injection or as THA performed 6-12 months, 3-6 months, or 0-3 months after injection. Risk adjustment was performed with multivariable regression.
  
  
  
  A total of 173,958 patients were included; 5421 (3.1%) underwent THA after an injection: 1395 (1.1%) of patients after 6-12 months, 1863 patients after 3-6 months, and 2163 (1.2%) after 0-3 months. In the 0-3 month group, PJI was significantly increased at 3 months (1.58%, P = .015), 6 months (1.76%, P = .022), and 1 year (2.04%, P = .031) compared with the noninjection control group (1.04%, 1.21%, and 1.47%, respectively). There were no differences in the 3- to 6-month and 6- to 12-month injection groups.
  
  
  
  There is an increased risk of PJI when THA is performed within 3 months of hip injection. We recommend that patients and their surgeons consider delaying elective THA until 3 months after an injection to avoid this elevated risk of infection.
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Mayman
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Jerabek
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D000556:Ambulatory Surgical Procedures; D001170:Arthritis, Infectious / Q000453:epidemiology / Q000209:etiology*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D017558:Elective Surgical Procedures; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects*; D007297:Inpatients; D008297:Male; D010003:Osteoarthritis / Q000628:therapy; D011184:Postoperative Period; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D020379:Risk Adjustment
chemical_list: D000305:Adrenal Cortex Hormones
keywords: complications; epidemiology; injection; periprosthetic joint infection; total hip arthroplasty