Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years
Purpose Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in no...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2023-02, Vol.31 (2), p.426-431 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Burnett, Robert A. Khalid, Syed DeBenedetti, Anne Terhune, E. Bailey Angotti, Morgan L. Della Valle, Craig J. |
| description | Purpose
Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA).
Methods
The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5 years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor.
Results
49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5 years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%;
p
|
| doi_str_mv | 10.1007/s00167-022-07017-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2684096493</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2772188868</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-4fc885ceffd9cc2c8ffe2150b819ccbe60fbd577b58daac4d13814f0253404d43</originalsourceid><addsrcrecordid>eNp9kU1uFDEQhS1ERIbABVggS2zYmJR_uu1ZoiiESJHYwNpy22XSk572YLuFZk7DWTgZTiaAxIKVy_L3XrnqEfKKwzsOoM8LAO81AyEYaOCaHZ6QFVdSMi2VfkpWsFaCCej6U_K8lA1AK9X6GTmVndayE3JFDtdzzY65XEe_TC5Tn-7LVCrmNAY6zhv0dUxzoS4jdaUkP7qKgX4f6y11NKSCLOAO54BzpXksdzRFWlN1E72bsWlyvc1pN7lS99RV2v38sUeXywtyEt1U8OXjeUa-fLj8fPGR3Xy6ur54f8O8hK4yFb0xnccYw9p74U2MKHgHg-HtPmAPcQhtnqEzwTmvApeGqwiikwpUUPKMvD367nL6tmCpdjsWj9PkZkxLsaI3CtZtMbKhb_5BN2nJc_udFVoLbozpTaPEkfI5lZIx2l0ety7vLQd7n4w9JmNbMvYhGXtooteP1suwxfBH8juKBsgjUNrT_BXz397_sf0FQladBw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2772188868</pqid></control><display><type>article</type><title>Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals - AutoHoldings</source><creator>Burnett, Robert A. ; Khalid, Syed ; DeBenedetti, Anne ; Terhune, E. Bailey ; Angotti, Morgan L. ; Della Valle, Craig J.</creator><creatorcontrib>Burnett, Robert A. ; Khalid, Syed ; DeBenedetti, Anne ; Terhune, E. Bailey ; Angotti, Morgan L. ; Della Valle, Craig J.</creatorcontrib><description>Purpose
Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA).
Methods
The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5 years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor.
Results
49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5 years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%;
p
< 0.001) and unmatched cohort (0.26 vs. 0.10%,
p
< 0.001). The quantity of CSI corresponded with an increased probability of TKA at 5 years; one injection: 0.22% (OR 1.23, 95% CI [0.87–1.74],
p
= 0.236); two injections: 0.39% (OR 1.98 CI [1.06–3.67],
p
= 0.03, three or more injections: 0.49% (OR 3.22 CI [1.60–6.48],
p
= 0.001). The average time to TKA after one CSI was 3.03 ± 2.29 years. This time was nearly halved with three CSI (1.78 ± 0.80 years,
p
< 0.001).
Conclusions
Intra-articular corticosteroid injections in patients without knee osteoarthritis at the time of injection are associated with a dose-dependent risk of TKA at 5 years. CSI may not be as benign of a treatment modality as previously thought.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-022-07017-z</identifier><identifier>PMID: 35773523</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adrenal Cortex Hormones - adverse effects ; Arthritis ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee - adverse effects ; Humans ; Injection ; Injections, Intra-Articular - adverse effects ; Joint replacement surgery ; Knee ; Knee Joint - surgery ; Medicine ; Medicine & Public Health ; Orthopaedic implants ; Orthopedics ; Osteoarthritis ; Osteoarthritis, Knee - drug therapy ; Osteoarthritis, Knee - etiology ; Osteoarthritis, Knee - surgery ; Pain ; Pain - surgery ; Regression analysis ; Risk analysis ; Risk factors ; Sports Medicine ; Statistical analysis ; Steroids</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-02, Vol.31 (2), p.426-431</ispartof><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2022</rights><rights>2022. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).</rights><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-4fc885ceffd9cc2c8ffe2150b819ccbe60fbd577b58daac4d13814f0253404d43</citedby><cites>FETCH-LOGICAL-c305t-4fc885ceffd9cc2c8ffe2150b819ccbe60fbd577b58daac4d13814f0253404d43</cites><orcidid>0000-0001-9788-1446</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-022-07017-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-022-07017-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35773523$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burnett, Robert A.</creatorcontrib><creatorcontrib>Khalid, Syed</creatorcontrib><creatorcontrib>DeBenedetti, Anne</creatorcontrib><creatorcontrib>Terhune, E. Bailey</creatorcontrib><creatorcontrib>Angotti, Morgan L.</creatorcontrib><creatorcontrib>Della Valle, Craig J.</creatorcontrib><title>Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA).
Methods
The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5 years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor.
Results
49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5 years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%;
p
< 0.001) and unmatched cohort (0.26 vs. 0.10%,
p
< 0.001). The quantity of CSI corresponded with an increased probability of TKA at 5 years; one injection: 0.22% (OR 1.23, 95% CI [0.87–1.74],
p
= 0.236); two injections: 0.39% (OR 1.98 CI [1.06–3.67],
p
= 0.03, three or more injections: 0.49% (OR 3.22 CI [1.60–6.48],
p
= 0.001). The average time to TKA after one CSI was 3.03 ± 2.29 years. This time was nearly halved with three CSI (1.78 ± 0.80 years,
p
< 0.001).
Conclusions
Intra-articular corticosteroid injections in patients without knee osteoarthritis at the time of injection are associated with a dose-dependent risk of TKA at 5 years. CSI may not be as benign of a treatment modality as previously thought.</description><subject>Adrenal Cortex Hormones - adverse effects</subject><subject>Arthritis</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Humans</subject><subject>Injection</subject><subject>Injections, Intra-Articular - adverse effects</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopaedic implants</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis, Knee - drug therapy</subject><subject>Osteoarthritis, Knee - etiology</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Pain</subject><subject>Pain - surgery</subject><subject>Regression analysis</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Sports Medicine</subject><subject>Statistical analysis</subject><subject>Steroids</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1uFDEQhS1ERIbABVggS2zYmJR_uu1ZoiiESJHYwNpy22XSk572YLuFZk7DWTgZTiaAxIKVy_L3XrnqEfKKwzsOoM8LAO81AyEYaOCaHZ6QFVdSMi2VfkpWsFaCCej6U_K8lA1AK9X6GTmVndayE3JFDtdzzY65XEe_TC5Tn-7LVCrmNAY6zhv0dUxzoS4jdaUkP7qKgX4f6y11NKSCLOAO54BzpXksdzRFWlN1E72bsWlyvc1pN7lS99RV2v38sUeXywtyEt1U8OXjeUa-fLj8fPGR3Xy6ur54f8O8hK4yFb0xnccYw9p74U2MKHgHg-HtPmAPcQhtnqEzwTmvApeGqwiikwpUUPKMvD367nL6tmCpdjsWj9PkZkxLsaI3CtZtMbKhb_5BN2nJc_udFVoLbozpTaPEkfI5lZIx2l0ety7vLQd7n4w9JmNbMvYhGXtooteP1suwxfBH8juKBsgjUNrT_BXz397_sf0FQladBw</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Burnett, Robert A.</creator><creator>Khalid, Syed</creator><creator>DeBenedetti, Anne</creator><creator>Terhune, E. Bailey</creator><creator>Angotti, Morgan L.</creator><creator>Della Valle, Craig J.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9788-1446</orcidid></search><sort><creationdate>20230201</creationdate><title>Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years</title><author>Burnett, Robert A. ; Khalid, Syed ; DeBenedetti, Anne ; Terhune, E. Bailey ; Angotti, Morgan L. ; Della Valle, Craig J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-4fc885ceffd9cc2c8ffe2150b819ccbe60fbd577b58daac4d13814f0253404d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adrenal Cortex Hormones - adverse effects</topic><topic>Arthritis</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Humans</topic><topic>Injection</topic><topic>Injections, Intra-Articular - adverse effects</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Knee Joint - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopaedic implants</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis, Knee - drug therapy</topic><topic>Osteoarthritis, Knee - etiology</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Pain</topic><topic>Pain - surgery</topic><topic>Regression analysis</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Sports Medicine</topic><topic>Statistical analysis</topic><topic>Steroids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burnett, Robert A.</creatorcontrib><creatorcontrib>Khalid, Syed</creatorcontrib><creatorcontrib>DeBenedetti, Anne</creatorcontrib><creatorcontrib>Terhune, E. Bailey</creatorcontrib><creatorcontrib>Angotti, Morgan L.</creatorcontrib><creatorcontrib>Della Valle, Craig J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burnett, Robert A.</au><au>Khalid, Syed</au><au>DeBenedetti, Anne</au><au>Terhune, E. Bailey</au><au>Angotti, Morgan L.</au><au>Della Valle, Craig J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>31</volume><issue>2</issue><spage>426</spage><epage>431</epage><pages>426-431</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Intra-articular corticosteroid injections (CSI) are used commonly for the non-operative management of patients with knee pain. Recent literature has raised concern for chondrotoxicity of CSI. The purpose of the present study is to evaluate for any dose-dependent association between CSI in non-osteoarthritic knees and subsequent total knee arthroplasty (TKA).
Methods
The Pearl Diver database identified patients with a diagnosis of knee pain without concomitant osteoarthritis who were administered CSI over a 2-year period. Patients were compared to matched and unmatched cohorts. The primary endpoint was the incidence of TKA at 5 years. Multivariable regression analysis was used to assess CSI quantity as an independent risk factor.
Results
49,443 of 986,162 (5.0%) Patients diagnosed with knee pain without concomitant knee osteoarthritis who received at least one CSI were identified. At 5 years, there was a higher incidence of TKA in the matched injection cohort relative to the non-injection matched cohort (0.26 vs 0.13%;
p
< 0.001) and unmatched cohort (0.26 vs. 0.10%,
p
< 0.001). The quantity of CSI corresponded with an increased probability of TKA at 5 years; one injection: 0.22% (OR 1.23, 95% CI [0.87–1.74],
p
= 0.236); two injections: 0.39% (OR 1.98 CI [1.06–3.67],
p
= 0.03, three or more injections: 0.49% (OR 3.22 CI [1.60–6.48],
p
= 0.001). The average time to TKA after one CSI was 3.03 ± 2.29 years. This time was nearly halved with three CSI (1.78 ± 0.80 years,
p
< 0.001).
Conclusions
Intra-articular corticosteroid injections in patients without knee osteoarthritis at the time of injection are associated with a dose-dependent risk of TKA at 5 years. CSI may not be as benign of a treatment modality as previously thought.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35773523</pmid><doi>10.1007/s00167-022-07017-z</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-9788-1446</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-02, Vol.31 (2), p.426-431 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2684096493 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; SpringerLink Journals - AutoHoldings |
| subjects | Adrenal Cortex Hormones - adverse effects Arthritis Arthroplasty (knee) Arthroplasty, Replacement, Knee - adverse effects Humans Injection Injections, Intra-Articular - adverse effects Joint replacement surgery Knee Knee Joint - surgery Medicine Medicine & Public Health Orthopaedic implants Orthopedics Osteoarthritis Osteoarthritis, Knee - drug therapy Osteoarthritis, Knee - etiology Osteoarthritis, Knee - surgery Pain Pain - surgery Regression analysis Risk analysis Risk factors Sports Medicine Statistical analysis Steroids |
| title | Intra-articular corticosteroid injections are associated with a dose-dependent risk of total knee arthroplasty at 5 years |
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