From the Research
Steroid injections should not be administered into a knee replacement within 3 months before or after the surgery due to the increased risk of periprosthetic joint infection, but they can be considered in patients with persistent pain and inflammation after knee replacement, with caution and strict sterile technique. The decision to administer steroid injections into a knee replacement should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 1. Corticosteroid injections such as methylprednisolone (40-80 mg) or triamcinolone (20-40 mg), typically mixed with a local anesthetic like lidocaine, may be used to treat persistent pain and inflammation in a prosthetic knee joint. The procedure should be performed by an orthopedic surgeon or interventional pain specialist using strict sterile technique to minimize infection risk, which is the primary concern with injecting into a prosthetic joint.
Some key points to consider when administering steroid injections into a knee replacement include:
- The timing of the injection: injections should be avoided within 3 months before or after knee replacement surgery due to the increased risk of infection 1, 2
- The type of injection: corticosteroid injections are commonly used, but hyaluronic acid injections may also be considered 1
- The frequency of injections: the frequency should be limited to no more than 3-4 injections per year to avoid potential complications 3
- The patient's individual risk factors: patients with a history of infection, diabetes, or other comorbidities may be at increased risk of complications from steroid injections 2
While steroids can provide temporary relief by reducing inflammation, they don't address underlying mechanical issues with the prosthesis and carry small risks of infection, joint damage, and systemic effects. Patients should be informed that any sudden increase in pain, redness, or swelling after injection requires immediate medical attention as these could indicate infection, which is particularly serious in prosthetic joints. According to a recent study, corticosteroid injections can be effective in reducing pain and inflammation in patients with knee replacements, with 76.6% of patients reporting decreased pain and 65.4% reporting long-term decreased swelling 3. However, the risks and benefits of steroid injections should be carefully weighed, and alternative treatments such as physical therapy, oral anti-inflammatories, and activity modification should be considered before administering injections.