Abstract：
OBJECTIVE: Corticosteroid injections are often used to manage glenohumeral arthritis in patients who may be candidates for future total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (rTSA). In the conservative management of these patients, corticosteroid injections are often provided for symptomatic relief. The purpose of this study was to determine if the timing of corticosteroid injections prior to TSA or rTSA is associated with changes in rates of revision and periprosthetic joint infection (PJI) following these procedures.
METHODS: Data were collected from a national insurance database from January 2006 to December 2017. Patients who underwent shoulder corticosteroid injection within one year prior to ipsilateral TSA or rTSA were identified and stratified into the following cohorts: < three months, three to six months, six to nine months, and nine to 12 months from time of corticosteroid injection to TSA or rTSA. A control cohort with no corticosteroid injection within one year prior to TSA or rTSA was used for comparison. Univariate and multivariate analyses were conducted to determine the association between specific time intervals and outcomes.
RESULTS: In total, 4,252 patients were included in this study. Among those, 1,632 patients (38.4%) received corticosteroid injection(s) within one year prior to TSA or rTSA and 2,620 patients (61.6%) did not. On multivariate analysis, patients who received corticosteroid injection < three months prior to TSA or rTSA were at significantly increased risk for revision (odds ratio (OR) 2.61 (95% confidence interval (CI) 1.77 to 3.28); p < 0.001) when compared with the control cohort. However, there was no significant increase in revision risk for all other timing interval cohorts. Notably, Charlson Comorbidity Index ≥ 3 was a significant independent risk factor for all-cause revision (OR 4.00 (95% CI 1.40 to 8.92); p = 0.036).
CONCLUSIONS: There is a time-dependent relationship between the preoperative timing of corticosteroid injection and the incidence of all-cause revision surgery following TSA or rTSA. This analysis suggests that an interval of at least three months should be maintained between corticosteroid injection and TSA or rTSA to minimize risks of subsequent revision surgery. Cite this article: Bone Joint J 2022;104-B(5):620-626.
METHODS: Data were collected from a national insurance database from January 2006 to December 2017. Patients who underwent shoulder corticosteroid injection within one year prior to ipsilateral TSA or rTSA were identified and stratified into the following cohorts: < three months, three to six months, six to nine months, and nine to 12 months from time of corticosteroid injection to TSA or rTSA. A control cohort with no corticosteroid injection within one year prior to TSA or rTSA was used for comparison. Univariate and multivariate analyses were conducted to determine the association between specific time intervals and outcomes.
RESULTS: In total, 4,252 patients were included in this study. Among those, 1,632 patients (38.4%) received corticosteroid injection(s) within one year prior to TSA or rTSA and 2,620 patients (61.6%) did not. On multivariate analysis, patients who received corticosteroid injection < three months prior to TSA or rTSA were at significantly increased risk for revision (odds ratio (OR) 2.61 (95% confidence interval (CI) 1.77 to 3.28); p < 0.001) when compared with the control cohort. However, there was no significant increase in revision risk for all other timing interval cohorts. Notably, Charlson Comorbidity Index ≥ 3 was a significant independent risk factor for all-cause revision (OR 4.00 (95% CI 1.40 to 8.92); p = 0.036).
CONCLUSIONS: There is a time-dependent relationship between the preoperative timing of corticosteroid injection and the incidence of all-cause revision surgery following TSA or rTSA. This analysis suggests that an interval of at least three months should be maintained between corticosteroid injection and TSA or rTSA to minimize risks of subsequent revision surgery. Cite this article: Bone Joint J 2022;104-B(5):620-626.
摘要：
目的：皮质类固醇注射常被用于治疗可能未来行全肩关节置换术（TSA）或反向肩关节置换术（rTSA）的患者的肱骨关节炎。在这些患者的保守治疗中，通常提供皮质类固醇注射以缓解症状。这项研究的目的是确定在TSA或rTSA之前注射皮质类固醇的时机是否与这些程序后的翻修率和假体周围感染（PJI）的变化有关。
方法：数据收集自2006年1月至2017年12月的国家保险数据库。在同侧TSA或rTSA前一年内接受肩部皮质类固醇注射的患者被确定并分层为以下队列：<3个月，三到六个月,六到九个月,从皮质类固醇注射到TSA或rTSA的9到12个月。使用在TSA或rTSA之前一年内未注射皮质类固醇的对照组进行比较。进行单变量和多变量分析以确定特定时间间隔和结果之间的关联。
结果：总计，本研究包括4,252名患者。其中,1,632名患者（38.4％）在TSA或rTSA之前的一年内接受了皮质类固醇注射，2,620名患者（61.6％）没有。在多变量分析中，与对照组相比,在TSA或rTSA治疗前<3个月接受皮质类固醇注射的患者的修正风险显著增加(比值比(OR)2.61(95%可信区间(CI)1.77~3.28;p<0.001).然而,所有其他时间间隔队列的修订风险均无显著增加.值得注意的是,Charlson合并症指数≥3是全因修正的显著独立危险因素(OR4.00(95%CI1.40至8.92);p=0.036)。
结论：术前皮质类固醇注射时机与TSA或rTSA后全因翻修手术的发生率之间存在时间依赖性关系。该分析表明，皮质类固醇注射与TSA或rTSA之间应保持至少三个月的间隔，以最大程度地减少后续翻修手术的风险。引用本文：骨关节J2022；104-B（5）：620-626。
方法：数据收集自2006年1月至2017年12月的国家保险数据库。在同侧TSA或rTSA前一年内接受肩部皮质类固醇注射的患者被确定并分层为以下队列：<3个月，三到六个月,六到九个月,从皮质类固醇注射到TSA或rTSA的9到12个月。使用在TSA或rTSA之前一年内未注射皮质类固醇的对照组进行比较。进行单变量和多变量分析以确定特定时间间隔和结果之间的关联。
结果：总计，本研究包括4,252名患者。其中,1,632名患者（38.4％）在TSA或rTSA之前的一年内接受了皮质类固醇注射，2,620名患者（61.6％）没有。在多变量分析中，与对照组相比,在TSA或rTSA治疗前<3个月接受皮质类固醇注射的患者的修正风险显著增加(比值比(OR)2.61(95%可信区间(CI)1.77~3.28;p<0.001).然而,所有其他时间间隔队列的修订风险均无显著增加.值得注意的是,Charlson合并症指数≥3是全因修正的显著独立危险因素(OR4.00(95%CI1.40至8.92);p=0.036)。
结论：术前皮质类固醇注射时机与TSA或rTSA后全因翻修手术的发生率之间存在时间依赖性关系。该分析表明，皮质类固醇注射与TSA或rTSA之间应保持至少三个月的间隔，以最大程度地减少后续翻修手术的风险。引用本文：骨关节J2022；104-B（5）：620-626。
