Steroid Injections Before Knee Replacement Increases Risk of Complications

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We’ve known for a long time now that injecting high-dose steroids into arthritic or painful knees is a dumb idea. Now, new research shows that if a patient who gets a steroid injection goes on to get a knee replacement, they are at higher risk for a complication. I’ll review in a moment, but first, let’s talk about steroids.

Why Steroids for Knee Pain and Arthritis?

Each year, millions of patients receive steroid injections for knee pain and arthritis as well as pain and swelling in many other musculoskeletal structures; in fact, corticosteroid injections are the most common injections given for pain and swelling not just in the U.S. but worldwide. While steroids may be a powerhouse drug that can temporarily relieve pain and swelling, unfortunately, the high-dose steroids that are typically injected can be toxic to cells and other body tissues.

In addition, while that first shot may seem to miraculously eliminate your pain, the effect is only temporary, and with each subsequent steroid shot, that pain relief typically diminishes. There’s also a question as to whether steroids really are the powerhouse drugs they get credit for as many studies suggest the relief provided after a steroid injection is actually due to the anesthetic used with the steroid, not the steroid itself. Research has also found that there’s no significant improvement in knee pain and arthritis when comparing a steroid injection with a placebo, and the patients receiving steroid injections experienced twice the amount of cartilage loss when compared to those receiving the placebo.

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Steroid Injections and Hip or Knee Replacement Are a Bad Combo

The purpose of the new study was to determine what factors put arthritis patients undergoing joint replacement, such as knee or hip replacement, at a higher risk for complications and infections following surgery. The study consisted of 1,150 joint replacement patients, and comorbidities and treatments prior to surgery were determined as well as complications following surgery.

Results from the study (table 2, page 5) show that you are 2.14 times as likely to get a complication after joint replacement if you’ve had a steroid injection. This makes steroid injections one of the biggest risks for complications (only having a respiratory problem, anemia, a mental illness, or rheumatoid arthritis was worse). In addition, you are also 3.16 times as likely to get an infection if you’ve had steroid injections and then have a joint replacement. Why? Steroids inhibit the immune system, and what is the job of the immune system? To fight infections!

Steroids, Hip Replacements, and Infection Risks: The Links Are Well Established

This isn’t the first time we’ve seen links between steroids, hip replacements, and infection risks. I’ve covered a few studies in the past showing that steroid injections in the hip are associated with higher infection rates when followed by hip replacement. For example, when comparing hip replacement patients who had steroid shots prior to surgery to hip replacement patients who did not, surgical infection risk in the steroid group increased by 37%. Even more telling, there was a 53% increased risk for hip replacement failure that resulted in a second hip replacement, and the primary reason for this was an infection. The problem isn’t just limited to steroid injections; oral steroid use has also been linked to joint infections following hip replacement and other joint replacements.

The upshot? Steroids are used like holy water out there, so you need to be an educated patient to avoid being a victim of this common, but clearly misguided medical practice. What can you try instead? A PRP (platelet-rich plasma) shot has no known side effects and may actually help rather than destroy the cartilage in the joint. It may cost you some out-of-pocket expense, but, thankfully, it likely won’t wreck your joint if you need a replacement down the road.


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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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