From the Guidelines
Intraarticular injections into joints with hardware should generally be avoided unless absolutely necessary due to increased risk of infection. The presence of hardware creates a potential surface for bacterial colonization and biofilm formation, which significantly increases infection risk compared to native joints 1. If an injection is deemed necessary, it should be performed with extreme caution, strict aseptic technique, and preferably by a specialist experienced in such procedures.
Key Considerations
- The standard medications used for intraarticular injections include corticosteroids (such as methylprednisolone 40-80mg or triamcinolone 20-40mg) and hyaluronic acid preparations, but these should only be administered after careful risk-benefit analysis in joints with hardware 1.
- Alternative pain management approaches such as physical therapy, oral medications, or injections in surrounding soft tissues may be safer options.
- Patients should be monitored closely after any injection into a joint with hardware for signs of infection including increased pain, swelling, warmth, redness, or fever.
Evidence-Based Recommendations
- A recent study published in 2023 by the American College of Rheumatology and American Association of Hip and Knee Surgeons conditionally recommends proceeding to total joint arthroplasty without delay over delaying surgical treatment for a trial of intraarticular glucocorticoid injections 1.
- The EULAR recommendations for intra-articular therapies emphasize the importance of careful patient selection, accurate injection technique, and strict aseptic precautions to minimize the risk of infection and other complications 1.
Clinical Implications
- Intraarticular injections into joints with hardware require careful consideration of the potential risks and benefits, and alternative treatment options should be explored before proceeding with injection therapy.
- If infection occurs in a joint with hardware, it often requires surgical intervention, hardware removal, and extended antibiotic therapy, highlighting the need for caution and careful patient monitoring.
From the Research
Intraarticular Injections into Joints with Hardware
- The safety of administering intraarticular injections into joints with hardware is a topic of interest, with several studies investigating the potential risks and benefits 2, 3, 4, 5, 6.
- A study published in the Journal of clinical orthopaedics and trauma found that intra-articular corticosteroid or hyaluronic acid injections are associated with an increased time to total joint arthroplasty, but the clinical significance of this delay is debatable 2.
- Another study published in The journal of knee surgery found that intra-articular injections given within the 4-month period prior to total knee arthroplasty were not associated with elevated periprosthetic joint infection risk 3.
- However, a study published in The Journal of arthroplasty found that multiple hip intra-articular steroid injections increase the risk of periprosthetic joint infection compared with single injections 4.
- In terms of the general safety of intra-articular injections, a review published in Anesthesiology clinics discussed the history, agents, and methods of intra-articular injections, highlighting their potential benefits for treating joint pain 5.
- Additionally, a study published in The bone & joint journal found that intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty, suggesting a conservative approach to treating patients with these injections 6.
Key Findings
- Intra-articular injections may be safe if administered at least three months preoperatively 2.
- The risk of periprosthetic joint infection may be increased with multiple intra-articular steroid injections 4.
- Intra-articular corticosteroid injections may increase the risk of requiring knee arthroplasty 6.
- The timing and type of intra-articular injection may affect the risk of complications 3.