The effect of pre-operative shoulder injections on post-operative opioid use, infection and revision following shoulder arthroplasty

Nicholas J Lemme; Daniel Yang; Christopher Lama; Edward J Testa; Myles Dworkin; Jacob M Modest; Brett D Owens; Alan H Daniels; Steven F DeFroda

doi:10.1177/17585732221114647

The effect of pre-operative shoulder injections on post-operative opioid use, infection and revision following shoulder arthroplasty

Shoulder Elbow. 2023 Sep;15(1 Suppl):87-94. doi: 10.1177/17585732221114647. Epub 2022 Jul 21.

Authors

Nicholas J Lemme¹, Daniel Yang¹, Christopher Lama¹, Edward J Testa¹, Myles Dworkin¹, Jacob M Modest¹, Brett D Owens¹, Alan H Daniels¹, Steven F DeFroda²

Affiliations

¹ Department of Orthopaedic Surgery, Brown University, Providence, RI, USA.
² Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.

PMID: 37692872
PMCID: PMC10492524 (available on 2024-09-01)
DOI: 10.1177/17585732221114647

Abstract

Background: Treatment of glenohumeral osteoarthritis (GHOA) may include conservative management with use of intraarticular injections, prior to considering total shoulder arthroplasty (TSA). The purpose of this study was to assess trends in the use of preoperative cortisone (CO) and hyaluronic acid (HA) injections, as well as investigate the relationship between injection use and infection or revision arthroplasty following TSA.

Methods: Pearl Driver was used to identify all patients undergoing TSA for GHOA between 2010 and 2018. Patients were categorized based on the type and number of injections they received. Outcomes of interest included post-operative opioid use, post-operative infection, and risk of revision surgery within 1 year of the index procedure.

Results: The incidence of patients receiving a CO or HA injections within 1 year of their TSA decreased by 83% and 54%, respectively. Patients who had received 1 or more steroid injections had higher odds of prolonged opiate use following surgery. Patients that received 1 or 2 CO injection prior to TSA had an increased risk of needing revision surgery.

Discussion: Use of intraarticular injections for the management of GHOA has declined. Patients receiving preoperative injections had increased odds of prolonged opiate use and the need for revision surgery.

Keywords: cortisone; injection; revision arthroplasty; shoulder arthroplasty.