I’ve blogged quite a bit on the inconvenient truth that while steroid medications are powerful anti-inflammatories that are commonly used without much medical thought, they’re really bad for your body. As one example, a prior highlighted study had shown that getting a hip steroid shot increases the likelihood that a hip replacement surgery will fail and/or the patient will get a nasty post-op infection. Now a new study found joint replacement infection to be one of the side effects of steroids prescribed orally as well.
Steroids in the Water Supply
I see it every day in clinical practice: doctors use high-dose steroids like they’re sprinkling holy water. Got back pain? Let’s get you some steroid pills. How about a sore knee or hip? Let’s inject some steroids. In fact, I just spoke to a patient on Tuesday of this week about the fact that a local physician had injected his hip with steroids. He really had no idea that this choice not only endangered the joint through additional damage caused by the medications but also increased his risk for a hip replacement failure or infection. So before we move on to the new study, let’s review a few prior posts on the side effects of steroids and just how bad steroids can be for you:
- A hip steroid shot given during the year prior to hip replacement surgery increases the risk for surgical infection by 37% and risk of a second hip replacement surgery (within two years of the first replacement) by 53%.
- Steroids, in the usual doses, kill mesenchymal stem cells (the most common stem cells used to treat orthopedic conditions).
- Taking oral steroids increases the risk of osteonecrosis of the hip.
- Steroid shots may provide short-term relief, but they inhibit healing, and pain will return with more severity.
- For up to three weeks following a steroid injection, the steroid suppresses your response to stress by negatively affecting your hypothalamus-pituitary-adrenal axis (HPA axis)—the stress-management hormones.
- Epidural steroid injections increase the risk of spinal fractures by 29% with each shot.
The New Study: Side Effects of Steroids Used Orally
The new research looked at the insurance claims of more than two thousand knee, hip, and shoulder joint replacement patients in the U.S. They then also examined if certain medications had any impact on whether a postoperative joint infection was reported. Not surprisingly, patients who were on oral-steroid medications were about 60% more likely to get an infected joint. Medications for gout were also a culprit (allopurinol).
Why does this happen? It’s pretty simple. Steroids work by powerfully suppressing inflammation. While we all think of inflammation as a bad guy, it’s also how we heal and fight infection. So any drug that suppresses inflammation will increase the likelihood of an infection. Given that a joint replacement infection is nasty, where the patient must be on IV antibiotics and often has to have the artificial joint removed and replaced, it’s amazing that more physicians haven’t gotten the memo on steroids.
The upshot? The side effects of steroids are nasty. However, if you have joint pain, you’ll get offered steroid shots or pills—it’s almost a given. Given that it likely will hurt your chances of responding to a stem cell procedure or, at the least, increase the likelihood of a post-op infection, if you need a joint replacement, “just say no” to drugs!
What if you have had steroid injections ? Pain is in the knee. What do you do? Dont want pain meds if i can go without them. Pain is real.
Louise,
Pain is very real and affects many other things. The problem with steroid injections is they kill the local stem cells living in your knee making it impossible for them to repair the situation, so they escalate the problem rather than making it better. Please see: https://regenexx.com/blog/new-research-steroids-hammer-stem-cells/ https://regenexx.com/steroid-injection-risks/ Finding out what’s causing the pain in your knee and treating it nonsurgically is generally the plan forward. Please see: https://regenexx.com/the-regenexx-procedures/knee-surgery-alternative/
I have asthma and use Advair for it. It is my understanding that Advair has a steroid in it. I’ve been told I need knee replacement. I’m 55 years old will the steroid in Advair affect the replaced joint If I decide to replace it? Since I use Advair would stem cells be a option? I’ve also had 2 steroid injections into my knee. The first one helped the pain. I didn’t notice the second helping so I’ve decided to not get another injection.
Being on inhaled steroids can be an issue for stem cell procedures. Steroid injections into a joint increase the risk of infection or failure of the prosthesis in subsequent joint replacement surgeries. You would have to wait at least 6 weeks before considering a stem cell procedure.
Could you provide article about cortisone injections within a year of Total hip replacement causing a higher incident of revision? I’ve taken prednisone since 12/2015 for polymyalgia myalgia. In 2009, I had a parathyroid tumor removed. I had osseous bumps on both femur heads. And I had cortisone injections in both hips early August. It did not work for right hip. Two weeks later, I had another injection in right.
But the pain did not go away. I had a total right hip replacement in October. The femur head had collapsed due to avascular necrosis. I was better and scheduled 2nd left replacement in December. But within 3 weeks of surgery, I experienced night pain in right glute. I thought it was normal, but when going in for presurgery appt, they discovered the hip stem had moved. I ended up with a left replacement and a right revision.
Everything looked good 8 weeks post op. I was released. But soon pain came back on right. I returned. X-ray showed right hip stem moved again. CT scan showed a spiral crack.
I had a revision of a revision with a plate and bracing to hold the femur together.
So you understand my curiosity about the article. In so many ways, I feel that I am the perfect orthopedic storm.
Candace,
We have treated many patients whose AVN was caused by steroids. Here is the article: https://regenexx.com/blog/hip-arthritis-steroid-shots/ Please see: https://regenexx.com/blog/steroid-injection-risks/ Really hoping for the calm AFTER the storm for you!
I am 34 and need total hip. I also am taking Prednisone 60mg a day for my kidneys (IGa Nephropathy). Now, my orthopedic surgeon says I need to stop taking Prednisone and never get back onto it if I want to do the surgery. But I also know that I need to take it for my kidneys post surgery. What am I getting into? What is the best solution?
RADHA,
This is something your nephrologist and orthopedic surgeon will need to work together on. Studies show that taking oral steroids drastically increases the risk of Hip AVN; one study showed that taking them for a year increased the risk by 21,200%! If you were a Candidate for Hip AVN treatment, the steroids would also need to be discontinued.
I had a total knee replacement 11 yrs ago. Is taking a steroid inj or oral Prednisone today a bad ideal? And could it still possible cause a knee infection? Thank yoi
Hi Brenda,
Oral steroids and steroid injections suppress the body’s ability to deal with infection, are toxic to your local stem cells, can damage tendons and cause spinal fractures. All medical decisions re risk vs benefit.