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Intra-articular steroid injection at the time of knee arthroscopy increases risk of post-operative infection

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the risk of post-operative infection after intra-articular steroid injection at the time of knee arthroscopy at a single institution high-volume sports medicine practice.

Methods

The electronic medical record at a single institution was queried for all patients who underwent knee arthroscopy from 2011 to 2019. Patients were included if they underwent more simple arthroscopic procedures: diagnostic arthroscopy, meniscectomy, loose body removal, synovectomy, or microfracture. Patients were excluded if they underwent more complex procedures, such as ligament reconstruction, meniscus repair, or any open procedures. These patients’ medical records were then queried for current procedural terminology and international classification of disease codes indicating post-operative infection. Individual chart review was performed on this group of patients to determine if a true postoperative infection occurred within 6 months of the index arthroscopy. Patients were then categorized into “intra-operative steroid injection” versus “no steroid” based on each surgeon’s preferred intra-operative analgesic injection cocktail.

Results

A total of 6889 patients were identified, including 2416 (35.1%) who were given intra-articular steroid at the time of knee arthroscopy. Post-operative infection occurred in 10 patients (0.15%) at a median of 18 days (range 9–42 days), 7 who received intra-operative steroid injection (0.29%) and 3 who did not (0.067%), p = 0.040. The relative risk of infection for those who received intra-operative steroid injection was 4.32 times higher than those who did not, with a number needed to harm of 448. There were no significant differences in age, body mass index, smoking status, or the prevalence of diabetes between those who got infected and those who did not.

Conclusions

Knee infection following arthroscopic surgery is rare. Intra-operative steroid injection during arthroscopic knee surgery is associated with a 4.3-fold increased risk of subsequent knee infection. While the overall risk remains low, the use of intra-operative steroids is expected to result in one additional knee infection for every 448 arthroscopic procedures performed.

Level of evidence

IV.

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Funding

The authors received no funding for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA

    Morgan Kohls, Robert Magnussen, Sean Fitzpatrick, Christopher Kaeding, David Flanigan & Robert Duerr

Authors
  1. Morgan Kohls
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  2. Robert Magnussen
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  3. Sean Fitzpatrick
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  4. Christopher Kaeding
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  5. David Flanigan
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  6. Robert Duerr
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Correspondence to Robert Duerr.

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The authors declare that they have no conflict of interest.

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This study was approved by the Biomedical Institutional Research Board of The Ohio State University.

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Kohls, M., Magnussen, R., Fitzpatrick, S. et al. Intra-articular steroid injection at the time of knee arthroscopy increases risk of post-operative infection. Knee Surg Sports Traumatol Arthrosc 30, 1846–1853 (2022). https://doi.org/10.1007/s00167-021-06763-w

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  • DOI: https://doi.org/10.1007/s00167-021-06763-w

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