title: Multiple Hip Intra-Articular Steroid Injections Increase Risk of Periprosthetic Joint Infection Compared With Single Injections.
abstract: Patients with hip osteoarthritis often temporize their symptoms with multiple intra-articular steroid hip injections (IASHIs) before undergoing total hip arthroplasty (THA). Although there is recent evidence to suggest that IASHI can lead to an increased risk of future periprosthetic joint infection (PJI), the potential increase in risk of PJI after multiple IASHIs compared with single IASHI remains largely unknown. The aim of the study was to evaluate whether multiple IASHIs are associated with increased risk of PJI compared with single IASHI in THA patients.
  
  
  
  We evaluated 2 cohorts of patients consisting of 106 patients who received 2 or more IASHI in the year before THA and a matched group of 350 patients who received one IASHI in the 12 months before THA.
  
  
  
  The single and multiply-injected patient cohorts had an infection rate of 2.0% and 6.6% (7/350 and 7/106), respectively (P = .04, odds ratio 3.30) and average follow-up of 28.9 and 24.2 months. The 2 cohorts did not differ with regard to age, gender, American Society of Anesthesiologist score, presence of diabetes mellitus, or body mass index.
  
  
  
  In comparison with patients with single IASHI, multiple IASHIs are associated with an increased risk of PJI significantly higher than the elevated risk reported with single injection before THA. The present study findings would be clinically useful in counseling patients who are considering temporizing their symptoms with multiple IASHIs before undergoing THA.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Chambers
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Lacy
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ming Han Lincoln
authors.initials: MHL
authors.lastname: Liow
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: John Paul M
authors.initials: JPM
authors.lastname: Manalo
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Freiberg
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kwon
mesh_terms: D000368:Aged; D001170:Arthritis, Infectious / Q000209:etiology*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D013256:Steroids
keywords: infection; injection; multiple injections; periprosthetic joint infection; steroid; total hip arthroplasty