Low rate of subsequent surgery and serious complications following intra-articular steroid injection for base of thumb osteoarthritis: national cohort analysis

Jennifer C E Lane, Richard S Craig, Jonathan L Rees, Matthew D Gardiner, Abigail V Shaw, Michelle Spiteri, Rachel Kuo, Benjamin F Dean, Jane Green, Daniel Prieto-Alhambra, Dominic Furniss, Jennifer C E Lane, Richard S Craig, Jonathan L Rees, Matthew D Gardiner, Abigail V Shaw, Michelle Spiteri, Rachel Kuo, Benjamin F Dean, Jane Green, Daniel Prieto-Alhambra, Dominic Furniss

Abstract

Objectives: Intra-articular steroid injection is commonly used to treat base of thumb osteoarthritis (BTOA), despite a lack of large-scale data on safety and effectiveness. We estimate the incidence of serious complications and further procedures following BTOA injection, including the risk of post-operative serious surgical site infection for subsequent operative intervention.

Methods: Hospital Episode Statistics data linked to mortality records from 1 April 1998 to 31 March 2017 were used to identify all BTOA injections undertaken in adults in the National Health Service secondary care in England. Patients were followed up longitudinally until death or 31 March 2017. A multivariable regression with a Fine and Gray model adjusting for the competing risk of mortality in addition to age, sex and socioeconomic deprivation was used to identify factors associated with progression to further procedure. Secondary outcomes included serious complications after injection and subsequent surgical site infection.

Results: A total of 19 120 primary injections were performed during the 19-year period in 18 356 patients. Of these 76.5% were female; mean age 62 years (s.d. 10.6); 50.48% underwent further procedure; 22.40% underwent surgery. Median time to further intervention was 412 days (IQR 110-1945). Female sex was associated with increased risk of proceeding to surgery. Serious complication rate following injection was 0.04% (0.01-0.08) within 90 days. Of those proceeding to surgery 0.16% (0.06-0.34) presented with a wound infection within 30 days and 90 days, compared with an overall post-operative wound infection rate of 0.03% (0.02-0.05).

Conclusions: Very low rates of serious complications were identified following BTOA injections performed in secondary care; only one in five patients proceeded to subsequent surgery.

Clinical trial registration: clinicaltrials.gov, https://www.clinicaltrials.gov, NCT03573765.

Keywords: complications/adverse events; intra-articular injection; osteoarthritis; surgical procedures; thumb.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig . 1
Fig. 1
Data processing flow chart
Fig . 2
Fig. 2
Kaplan-Meier plots divided by sex for risk of (A) further procedure and (B) surgery after primary BTOA injection
Fig . 3
Fig. 3
Sunburst representing procedures that occurred following primary BTOA injection
Fig. 4
Fig. 4
Forest plot of factors associated with proceeding to further intervention following BTOA injection
Fig . 5
Fig. 5
Forest plot of factors associated with proceeding to surgery following BTOA injection

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