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Kalei Hering, BS
Pronouns
She/Her/Hers
Job Title
Academic Rank
Department
Orthopedics
Authors
Emily Parker BS, Kalei Hering BS, Christopher Chiodo MD, Eric Bluman MD PhD, Jeremy T. Smith MD, Elizabeth A. Martin MD
Principal Investigator
Elizabeth A. Martin MD
Research Category: Musculoskeletal/Orthopedics/Sports Medicine
Tags
Background: Intraarticular corticosteroid injections (ICIs) are widely used to treat foot and ankle conditions. While laboratory studies indicate certain corticosteroids and local anesthetics (LAs) used in ICIs are associated with chondrotoxic effects, clinical evidence is lacking. We aimed to identify the current ICI practice patterns of surgeons in the American Orthopaedic Foot and Ankle Society (AOFAS), including medication selection, perceptions of injectate chondrotoxicity, and rationale.
Methods: An e-survey including demographics, practice patterns and rationale was disseminated to 2,011 AOFAS members.
Results: In total, 387 surveys were completed. Lidocaine and triamcinolone were the most common anesthetic and corticosteroid (51.2% and 39.3%, respectively). Less than half of respondents felt corticosteroids or LAs bear risk of chondrotoxicity. Respondents agreeing corticosteroids are chondrotoxic were more likely to use triamcinolone (OR=1.55[1.03-2.23], p=0.037). Respondents agreeing LAs risk chondrotoxicity were less likely to use lidocaine (OR=0.62[0.41-0.92], p=0.023). Respondents choosing an LA based on literature were 9.64 times more likely to use ropivacaine (CI:[3.44-27.03], p<0.001).
Conclusion: Corticosteroid and LA use in ICIs varied greatly. Those who recognized potential chondrotoxicity and who chose based on literature were more likely to choose medications with less in vitro and in vivo chondrotoxic potential. Further studies are needed to determine clinical correlation and best practices.
Background: Intraarticular corticosteroid injections (ICIs) are widely used to treat foot and ankle conditions. While laboratory studies indicate certain corticosteroids and local anesthetics (LAs) used in ICIs may be toxic to joint tissues, clinical evidence is lacking. We aimed to identify the current ICI practice patterns of surgeons in the American Orthopaedic Foot and Ankle Society (AOFAS), including medication selection, perceptions of injectate chondrotoxicity, and rationale.
Methods: An e-survey including demographics, practice patterns and rationale was disseminated to 2,011 AOFAS members.
Results: In total, 387 surveys were completed. Lidocaine and triamcinolone were the most common anesthetic and corticosteroid (51.2% and 39.3%, respectively). Less than half of respondents felt corticosteroids or LAs bear risk of chondrotoxicity. Respondents agreeing corticosteroids are chondrotoxic were more likely to use triamcinolone (OR=1.55[1.03-2.23], p=0.037). Respondents agreeing LAs risk chondrotoxicity were less likely to use lidocaine (OR=0.62[0.41-0.92], p=0.023). Respondents choosing an LA based on literature were 9.64 times more likely to use ropivacaine (CI:[3.44-27.03], p<0.001).
Conclusion: Corticosteroid and LA use in ICIs varied greatly. Those who recognized potential chondrotoxicity and who chose based on literature were more likely to choose medications with less chondrotoxic potential. Further studies are needed to determine clinical correlation and best practices.
