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Analysis of small joint arthroplasty and arthrodesis complications after corticosteroid injections
Ricardo Rosales, MD
1; Hunter Faris, MD
1; Jian Li, BS, MPH
2; Andrea Yessaillian, BS
3; Asadullah Helal, MD
1; Lauren Dutton, MD
4; Katharine Hinchcliff, MD
51University of California San Diego, San Diego, CA; 2SUNY Upstate Medical University, Syracuse, NY; 3UC San Diego School of Medicine, La Jolla, CA; 4Naval Hospital Jacksonville, Jacksonville, FL; 5University of California, San Diego, San Diego, CA
Hypothesis:
Patients who receive intraarticular corticosteroid injections (CSIs) in the small joints of the hand and the distal radial ulnar joint (DRUJ) within 6 months of surgery have a higher rate of wound infection, reoperation, and overall complications compared to those who do not.
Methods:
This single-center, retrospective analysis included 149 patients undergoing operative treatment between January 2009 to December 2023. Joints analyzed included: each metacarpophalangeal (MCP), each proximal and distal interphalangeal (PIP and DIP), thumb interphalangeal (tIP), and DRUJ. Major complications were categorized as reoperation, superficial surgical site infection, and deep incisional surgical site infection. Minor complications were categorized as persistent pain, persistent swelling, triggering, delayed wound healing, hypersensitivity, pain, and hypertrophic scaring. Odds ratios were calculated using logistic regression analyses on major and minor complications for demographic, surgical factors, and steroid injection.
Results:
149 patients had 192 surgeries for 226 total joints with 36 patients receiving surgery on more than one joint at once. Mean follow-up time was 198 days. Of the 226 joints evaluated, 15.9% (n=36) had a CSI prior to surgical intervention with 7.96% (n=18) receiving one within 6 months. Of the 190 joints evaluated that did not receive a CSI, the major complication rate was 12.2% and the minor complication rate was 18.9%. Amongst the 36 joints that received a CSI, the major complication rate was 21.8% and the minor complication rate was 25.0%. Unadjusted logistic regression demonstrated that receiving a CSI did not affect the odds of having a major nor minor complication (p-value = 0.194 and p-value = 0.406, respectively). When CSI was adjusted for the type of surgery, there was not a significantly higher odds of having a major nor minor complication (p-value = 0.27 and p-value = 0.168, respectively). Adjusting for type of joint also did not yield significant major and minor odds ratios for those that received a CSI vs those that did not (p-value = 0.585, p-value = 0.989). Similar results were obtained for receiving a CSI within 6 months; there were no statistically significant differences in major and minor complications controlling for either type of surgery or joint.
Conclusions: Patients receiving CSI's preceding operative intervention of symptomatic arthritis of the small joints and DRUJ have no statistically significant differences in postoperative outcomes compared to patients who deferred CSI's. These results show that CSI may be safe to employ within 6 months of surgery. 
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