title: Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty : is it safe? a systematic review.
abstract: OBJECTIVE
  Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA).
  
  
  METHODS
  Studies dealing with an intra-articular corticosteroid injection to the hip and infection following subsequent THA were identified from databases for the period between 1990 to 2013. Retrieved articles were independently assessed for their methodological quality.
  
  
  RESULTS
  A total of nine studies met the inclusion criteria. Two recommended against a steroid injection prior to THA and seven found no risk with an injection. No prospective controlled trials were identified. Most studies were retrospective. Lack of information about the methodology was a consistent flaw.
  
  
  CONCLUSIONS
  The literature in this area is scarce and the evidence is weak. Most studies were retrospective, and confounding factors were poorly defined or not addressed. There is thus currently insufficient evidence to conclude that an intra-articular corticosteroid injection administered prior to THA increases the rate of infection. High quality, multicentre randomised trials are needed to address this issue. Cite this article: Bone Joint J 2016;98-B:1027-35.
authors.affiliation: Centre Hospitalier Universitaire Vaudois, Site Hôpital Orthopédique, Avenue Pierre Decker 4, CH-1011 Lausanne, Switzerland.
authors.forename: L C
authors.initials: LC
authors.lastname: Pereira
authors.affiliation: Therap-ease Treatment Centre, 382 Morningside Road, Edinburgh, EH10 5HX, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kerr
authors.affiliation: Centre Hospitalier Universitaire Vaudois, Site Hôpital Orthopédique, Avenue Pierre Decker 4, CH-1011 Lausanne, Switzerland.
authors.forename: B M
authors.initials: BM
authors.lastname: Jolles
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D004927:Escherichia coli Infections / Q000139:chemically induced; D006801:Humans; D007270:Injections, Intra-Articular; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods; D013203:Staphylococcal Infections / Q000139:chemically induced; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000139:chemically induced; D013530:Surgical Wound Infection / Q000209:etiology*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroid; Infection; Intra-articular steroid hip injection; Revision; Safety; Sepsis; Systematic review; Total hip arthroplasty