Prior knee or shoulder arthroscopy was associated with more infection after arthroplasty

Design

Meta-analysis of 31 observational studies

Population

Patients undergoing knee, hip or shoulder arthroplasty with or without prior arthroscopy

Primary outcome

Postoperative infection, overall and deep

Effect

Overall OR 1.33 (1.14–1.56); deep OR 1.38 (1.17–1.63); no association for hip

This meta-analysis pooled 31 observational studies on whether previous arthroscopic surgery on the same joint changes the infection risk after knee, hip or shoulder replacement.

Prior arthroscopy was associated with higher overall infection (OR 1.33, 95% CI 1.14–1.56) and deep infection (OR 1.38, 1.17–1.63), with marked differences between joints. The association held for knee arthroscopy and was strongest for deep infection after shoulder arthroscopy; there was no significant association for hip arthroscopy. The pooled infection rate in patients with prior arthroscopy was about 2%.

This is not a reason to refuse arthroplasty after arthroscopy, but it belongs in the consent conversation and in perioperative planning. It is also one more cost to weigh before offering arthroscopy for degenerative knees that are likely to need replacement later.

• Record any previous arthroscopy on the index joint in the preoperative assessment
• Include the modestly higher infection risk in consent for these patients
• Optimise modifiable infection risks — glucose control, skin condition, dental sepsis — with extra care
• Weigh future arthroplasty infection risk before offering arthroscopy for degenerative knee disease

Why it matters

A procedure many patients have years before replacement appears to add to later infection risk.

Don't overread it

Observational studies only — this shows an association, not that the arthroscopy itself caused the infections.

The statistics, in plain English

An odds ratio of 1.33 means about a third higher odds of infection. With infection rates around 2% in these patients, the absolute difference per patient is small, but it adds up across a busy arthroplasty service. The studies were observational, so patients who needed arthroscopy may differ in other ways that raise infection risk.

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