Special Considerations Before Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis with a Recent Corticosteroid Injection.

Abstract

Background: Rapidly progressive osteoarthritis (RPOA) has been associated with hip corticosteroid injections (CSIs), but may also mimic septic arthritis, which demonstrates similar erosive findings. This retrospective review evaluated a consecutive series of patients who had RPOA of the hip following CSI who underwent total hip arthroplasty (THA) and assessed outcomes and potential infection screening implications.

Methods: All radiographic reports concerning RPOA were retrospectively identified at a single academic referral center from January 2014 to January 2023. A total of 4,279 reports were identified, and after removing duplicates, 2,175 patients were individually chart-reviewed. Occurrence of RPOA was defined as chondrolysis of at least two millimeters per year or 50% of joint space loss within one year of a CSI of the hip. Patients who had prior malignancy, septic arthritis, oral corticosteroid use, or prior femoral head avascular necrosis were excluded.

Results: Ultimately, 81 patients, who had a mean follow-up time of two years, were identified who had undergone THA for RPOA following CSI. The average time between CSI and THA was 183.6 days (SD = 140.2). Preoperative infectious workup was performed in 31 patients who have inflammatory markers and eight patients who have a hip aspiration based on surgeon discretion. The mean aspiration cell counts and polymorphonuclear percentages were 1,410.8 (SD = 1,574.2) and 52.3% (SD = 23.3), respectively. Cultures were negative in all aspirations. All eight patients had negative aspirations and negative intraoperative cultures, and none developed periprosthetic joint infection (PJI). Of interest, two patients developed PJI within one month following THA, and neither underwent a preoperative infectious workup with labs or aspirations. Aside from these two PJIs, no other patients underwent repeat surgery.

Conclusion: The occurrence of RPOA of the hip following CSI was associated with an estimated 2.5% risk of PJI. Preoperative screening with inflammatory markers and possible joint aspiration should be considered prior to THA for patients who have CSI-related RPOA.