Steroid Shoulder Injection Before Total Hip Replacement: Safety Considerations
A steroid injection in the shoulder 4 days before total hip replacement surgery is safe to proceed with and does not increase the risk of surgical complications.
Rationale for Safety
The primary concern with steroid injections prior to joint replacement surgery relates to the timing and location of the injection:
Different anatomical sites: The shoulder injection is anatomically distant from the hip surgical site, eliminating direct contamination risk 1.
Systemic effects of steroids: According to the 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guidelines, patients can safely continue their current daily dose of glucocorticoids when undergoing total hip arthroplasty (THA) 1.
Timing considerations: The main concern with steroid injections is when they are administered into the same joint that will undergo replacement. In those cases, injections within 3 months prior to surgery may slightly increase infection risk 2, 3, 4.
Key Recommendations
Distant joint injections: Steroid injections in joints distant from the surgical site (like shoulder vs. hip) do not increase surgical risk 1.
Glucocorticoid management: The ACR/AAHKS guidelines recommend continuing the current daily dose of glucocorticoids in patients undergoing THA rather than administering "stress dosing" 1.
Monitoring considerations: For diabetic patients, be aware that there may be transient hyperglycemia following the steroid injection, particularly from days 1-3 post-injection 1, 2.
Important Distinctions
Same-joint concerns: The 3-month waiting period recommendation applies specifically to intra-articular injections in the same joint that will undergo replacement 2, 3, 4.
Infection risk data: Studies showing increased infection risk (from 0.5% to 1.0%) refer specifically to injections in the same joint that will undergo replacement 2, 4.
Dose-dependent relationship: A dose-dependent relationship between hip corticosteroid injections and subsequent infection risk has been observed, but this applies only to injections in the joint being replaced 3.
Practical Considerations
The patient can safely proceed with the total hip replacement as scheduled.
No special precautions are needed for a shoulder injection prior to hip surgery.
The patient should be advised about potential temporary exacerbation of shoulder pain (post-injection flare) that typically resolves within 24-48 hours 2.
The patient should avoid overuse of the injected shoulder for 24 hours but complete immobilization is not necessary 2.
In conclusion, a steroid injection in the shoulder 4 days before hip replacement surgery poses no contraindication to proceeding with the scheduled surgery, as the injection site is anatomically distant from the surgical site, and current guidelines support continuing normal glucocorticoid management during the perioperative period.