Effect of intra-articular hyaluronic acid agents on subsequent rate of infection following total knee arthroplasty

The aim of our study was to discover any relation between infection, including deep infections, after knee total joint arthroplasty in patients who had previous intra-articular hyaluronic acid injections compared to those who had not. We performed a retrospective review of 1776 patients who had osteoarthritis and received hyaluronic acid injections and then a subsample of 415 patients who subsequently underwent total joint arthroplasty: a large primary researchable database from 2002-2008. Surgery was conducted in a university academic network, while the hyaluronic acid injections were delivered in a large primary care arthritis referral center. The 415 patients had at least one year follow-up after total joint arthroplasty. Outcomes included demographics, pre-post total joint arthroplasty Western Ontario McMaster score, and clinical outcomes (knee flexion and extension), as well as adverse events including infection rates. Infections were determined on clinical grounds and confirmed with laboratory investigations. In the injection group there were 18 cases of infected total joint arthroplasty versus 21 in the no-hyaluronic-acid-injection group. However, when the type of hyaluronic acid derivative was considered, more infections with higher versus lower molecular weight (15 vs. 3) were observed. Hence, prior intra-articular hyaluronic acid does not increase the risk of subsequent infection post total joint arthroplasty.