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

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. The occurrence of RPOA was defined as chondrolysis of at least 2 mm per year or 50% of joint space loss within 1 year of a CSI of the hip. Patients who had prior malignancy, septic arthritis, oral corticosteroid use, or femoral head osteonecrosis were excluded.

RESULTS

Ultimately, 81 patients, who had a mean follow-up time of 2 years, were identified who had undergone THA for RPOA following CSI. 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). There were two patients who developed PJI within 1 month following THA, and neither underwent a preoperative infectious workup with labs or aspirations. No other patients underwent repeat surgery.

CONCLUSIONS

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.