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Study: No increased post-THA infection risk from intra-articular steroid injections

Two of the 36 patients complained of persistent hip pain postoperatively, but neither had evidence of deep infection.

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Using intra-articular steroid injections to help identify the source of hip pain does not appear to increase the risk of deep joint infection after patients later undergo total hip arthroplasty, a study by British researchers suggests.

Amol R. Chitre, MBChB, MRCS, and colleagues reviewed the incidence of deep joint infection among all patients treated with intra-articular steroid injections before receiving ipsilateral total hip arthroplasty (THA) between 1996 and 2000.

The study included 36 hips of 36 patients who met inclusion criteria. Patients averaged 63.7 years of age and underwent THA a mean of 18 months after receiving the intra-articular steroid injection, according to the study, published in the British edition of the Journal of Bone and Joint Surgery.

"In all instances, the primary aim of injection was to distinguish between pain of spinal origin and pain intrinsic to the hip," the authors reported. Members of the hospital's surgical team performed all injections in the operating theater using "strict sterile conditions," they noted.

During THA, all patients received intravenous antibiotics at the start of anesthesia and two additional doses postoperatively. Surgeons also used gentamicin-impregnated cement in all procedures.

Follow-up averaged 25.8 months. All patients had satisfactory radiographs and no evidence of loosening or infection prior to hospital discharge. In addition, all patients had satisfactory clinical outcomes at their latest follow-up, the authors noted.

No patients experienced superficial or deep infections requiring surgical intervention. Only two of the 36 patients (5.6%) complained of persistent hip pain, but neither patient had evidence of deep infection, according to the study.

"Our findings suggest that the practice of intra-articular steroid injection through a lateral approach to the hip is safe, provided a strict aseptic technique is adopted," the authors wrote.

For more information:

• Chitre AR, Fehily MJ, Bamford DJ. Total hip replacement after intra-articular injection of local anesthetic and steroid. J Bone Joint Surg Br. 2007;89-B:166-168.