Intra-articular hyaluronic acid injections less than 6 month
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Intra-articular hyaluronic acid (IAHA) can be injected into an osteoarthritic hip joint to reduce pain and to improve functionality. Several studies report IAHA to be safe, with minor adverse effects that normally disappear spontaneously within a week. However, intra-articular corticosteroids prior to total hip arthroplasty (THA) have been associated with increased infection rates. This association has never been investigated for IAHA and THA. Researchers aimed to assess the influence of IAHA on the outcome of total hip arthroplasty (THA), with an emphasis on the periprosthetic joint infection (PJI).

At a mean follow-up of 52 months (±18), researchers compared complication rates, including superficial and deep PJIs, of THA in patients who received an IAHA injection 6 months prior to surgery (injection group) with that of patients undergoing THA without any previous injection in the ipsilateral hip (control group). One-hundred thirteen patients (118 hips) could be retrospectively included in the injection group and 452 patients (495 hips) in the control group. No differences in baseline characteristics nor risk factors for PJI between the two groups were found. The clinical outcomes in terms of VAS pain scores, modified Harris Hip Scores (77 vs. 75 points) and Hip disability and Osteoarthritis Outcome Scores (79 vs. 76 points) did not differ between the injection group and the control group. However, in the injection group there was a higher rate of PJIs (4% vs. 0%) and postoperative wound infections (9% vs. 3%), compared to the control group.

In conclusion, this data suggest that patients receiving IAHA injections of the hip within six months to subsequent THA may be at risk for increased rates of PJI. While prospective studies are needed to confirm findings, researchers would presently recommend against performing THA within six months after IAHA administration.

Source: https://www.sciencedirect.com/science/article/pii/S0883540320310354?dgcid=rss_sd_all
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