American Association for Hand Surgery
Theme: Beyond Innovation

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Corticosteroid or Hyaluronic Acid Injections to the Thumb Carpometacarpal Joint are Associated with Early Complications after Subsequent Surgery
Aviram M Giladi, MD, MS1; Paymon Rahgozar, MD2; Lin Zhong, MD, MPH3; Kevin C. Chung, MD, MS3
1The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; 2University of California San Francisco Medical Center, San Francisco, CA; 3Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI

Corticosteroid or Hyaluronic Acid Injections to the Thumb Carpometacarpal Joint are Associated with Early Complications after Subsequent Surgery
Introduction: The utility and effectiveness of corticosteroid and hyaluronic acid (HA) injections for reducing symptoms associated with thumb carpometacarpal (CMC) arthritis is unclear. However, these treatments are still commonly used. If symptoms persist after injection, surgery is often required. The post-operative complication risks associated with corticosteroid and HA injections have been reported for many conditions but have not been investigated as related to surgery for thumb CMC arthritis. We hypothesize that corticosteroid and HA injections increase early post-operative surgical-site complications after thumb CMC arthritis surgery.
Materials and Methods: Truven MarketScan Databases were used to identify patients with CMC arthritis who underwent surgical treatment. Pre-operative corticosteroid or HA injections were identified, as were post-operative complications. Multivariable regressions evaluated the relationship between pre-operative injections and post-operative complications.
Results: Of 16,268 patients, 4,462 had steroid injections and 252 received HA injections. 21% had post-operative complications. Odds of any complication, most notably infectious complications, were increased 20% owing to corticosteroids (OR 1.2, 1.1-1.3, p<0.001). More than 3 corticosteroid injections increased the odds of a complication by 70% (OR 1.7, 1.3-2.1, p<0.001). In subgroup analysis of interposition arthroplasty patients, greater than 3 corticosteroid injections increased the odds of infectious complications by 80% (OR 1.8, 1.3-2.3, p<0.001) while HA injection increased the odds of wound healing complications by 110% (OR 2.1, 1.3-3.4, p<0.001).
Conclusions: Thumb CMC corticosteroid injections, especially when greater than 3 injections were given, increased the odds of surgical-site complications most notably infectious complications after CMC arthritis procedures. Although HA injections did not increase infectious complications, they did increase the odds of wound healing complications. Because the effectiveness of these commonly used injection treatments is debated, it is important to consider these complication risks within the CMC arthritis treatment algorithm.
Level of Evidence: III


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