Administering Corticosteroid Knee Injection with Contralateral DVT
It is safe to administer a corticosteroid knee injection for osteoarthritis in a patient with contralateral deep vein thrombosis (DVT) if the ultrasound of the knee to be injected appears normal.
Rationale for Safety Assessment
The presence of a DVT in one leg does not contraindicate a corticosteroid injection in the contralateral knee when proper assessment confirms the injection site is unaffected. This recommendation is based on several key considerations:
Localized vs. Systemic Risk: The NCCN guidelines for venous thromboembolic disease 1 focus on systemic anticoagulation management and do not identify local corticosteroid injections in unaffected limbs as contraindicated.
Normal Ultrasound Finding: The Society of Radiologists in Ultrasound consensus 1 emphasizes the importance of ultrasound assessment for DVT. A normal ultrasound of the knee to be injected confirms the absence of thrombosis at the injection site.
Anatomical Separation: The contralateral nature of the DVT means the thrombus is anatomically distant from the injection site, minimizing any direct risk of thrombus disruption.
Procedural Considerations
When performing the injection, follow these precautions:
- Confirm Normal Ultrasound: Ensure the ultrasound of the knee receiving the injection shows no evidence of DVT 1, 2
- Avoid Vascular Structures: Use proper injection technique to avoid inadvertent intravascular injection
- Monitor Post-Procedure: Observe for any unusual symptoms after injection
Special Precautions
While the procedure is generally safe, be aware of these important considerations:
- Rare Complications: There have been isolated case reports of arterial thrombosis 3 and superficial vein thrombosis 4 following knee corticosteroid injections, though these are extremely rare events
- Patient Education: Inform the patient about signs of potential complications to monitor for after the procedure
- Anticoagulation Status: If the patient is on anticoagulation for the contralateral DVT, this does not contraindicate the injection but may require monitoring for post-procedure bleeding
Post-Injection Monitoring
After the injection, advise the patient to:
- Monitor for any new swelling, pain, or redness in either leg
- Continue anticoagulation therapy for the existing DVT as prescribed
- Report any unusual symptoms promptly
- Follow up as scheduled for assessment of both the injected knee and the leg with DVT
Conclusion
The evidence supports that a corticosteroid knee injection can be safely administered in patients with contralateral DVT when ultrasound confirms no thrombosis at the injection site. The anatomical separation between the site of injection and the existing DVT minimizes any direct risk of thrombus disruption or extension.