Evidence map›Paper›PMID 35325263›Full record

SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022

Intra-articular injection receipt within 3 months prior to primary total knee arthroplasty is associated with increased periprosthetic joint infection risk.

Amanda Avila, Alexander J Acuña, Michael T Do, Linsen T Samuel, Atul F Kamath

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
3.5field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Amanda AvilaDepartment of Orthopaedic Surgery, Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Center for Hip Preservation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.
Alexander J AcuñaDepartment of Orthopaedic Surgery, Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Center for Hip Preservation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.
Michael T DoDepartment of Orthopaedic Surgery, Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Center for Hip Preservation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.
Linsen T SamuelDepartment of Orthopaedic Surgery, Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Center for Hip Preservation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.
Atul F KamathDepartment of Orthopaedic Surgery, Cleveland Clinic Foundation, Orthopaedic and Rheumatologic Institute, Center for Hip Preservation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA. kamatha@ccf.org.ORCID http://orcid.org/0000-0002-9214-2756
Cleveland Clinic · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis systematic review and meta-analysis analyzed the influence of pre-operative intra-articular injections (IAI) on periprosthetic joint infection (PJI) rates after primary total knee arthroplasty (TKA).

methodsStudies published between January 1st, 2000 and May 1st, 2021 evaluating PJI rates among TKA patients with and without IAI were identified from PubMed, Cochrane Library, MEDLINE, EBSCO Host, and Google Scholar. The pooled effect of IAI on PJI risk was calculated utilizing Mantel-Haenszel (M-H) models. Sub-analysis comparisons were conducted based on the interval from IAI to TKA: 0-3 months; > 3-6 months; > 6-12 months. The Methodological Index for Non-Randomized Studies (MINORS) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool were utilized to evaluate the quality of each included study.

resultsThe present analysis included 12 studies reporting on 349,605 TKAs (IAI: n = 115,122; No IAI: n = 234,483). Patients receiving an IAI at any point prior to TKA (2850/115,122; 2.48%) had statistically significant increased risk of infection compared to patients not receiving IAIs (4479/234,483; 1.91%; OR: 1.14, 95% CI: 1.08-1.20; p < 0.0001). However, this finding was not demonstrated across sensitivity analyses. Receiving injections within 3 months prior to TKA was associated with increased infection risk (OR: 1.23, 95% CI: 1.14-1.31; p < 0.0001). There were no differences in infection rates when injections were given between > 3 and 6 months (OR: 0.82, 95% CI: 0.47-1.43; p = 0.49) and > 6-12 months prior to TKA (OR: 1.26, 95% CI: 0.89-1.78; p = 0.18).

conclusionsBased on the current literature, the findings of this analysis suggest that patients receiving IAI should wait at least 3 months before undergoing TKA to mitigate infection risk. Orthopaedic surgeons and patients can utilize this information when undergoing shared decision-making regarding osteoarthritis management options and timing. LEVEL OF EVIDENCE: Level III.

Indexed as

Arthroplasty, Replacement, KneeInjections, Intra-ArticularProsthesis-Related InfectionsHumans3-Month waiting periodIncreased infection riskIntra-articular injections (IAIs)Meta-analysisPeriprosthetic joint infection (PJI)Systematic reviewTotal knee arthroplasty (TKA)

Identifiers

PMID35325263
OpenAlexW4221099831

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.