Safety of Ankle Cortisone Injection After Recent Total Knee Replacement
It is safe to receive an ankle cortisone injection after a recent total knee replacement, provided that at least 14 days have passed since surgery and the surgical wound shows evidence of healing with no signs of infection.
Timing Considerations
The timing of cortisone injections relative to joint replacement surgery is critical for minimizing infection risk:
Post-Surgery Timing
- Wait until the knee replacement surgical wound shows evidence of healing (typically ~14 days)
- Ensure all sutures/staples are removed
- Confirm there is no significant swelling, erythema, or drainage
- Verify there is no clinical evidence of infection at the surgical site or elsewhere 1
Pre-Surgery Timing (for future reference)
- Cortisone injections should be avoided within 3 months before planned joint replacement surgery 2
- The most recent evidence suggests that injections within 2-4 weeks before total knee arthroplasty are particularly associated with increased infection risk 3
- A 2023 meta-analysis found that for hip arthroplasty (though not for knee), the risk of periprosthetic joint infection is higher if injections are performed within 3 months preoperatively 4
Injection Technique and Safety Considerations
When performing the ankle cortisone injection after total knee replacement:
- Use strict aseptic technique to minimize infection risk 2
- Change needles between drawing medication and injecting into the joint 2
- Consider ultrasound guidance for accurate placement 2
- Monitor patients with diabetes for transient hyperglycemia during days 1-3 post-injection 2
Special Considerations After Total Knee Replacement
- Patients who have recently undergone total knee arthroplasty may be taking antirheumatic medications that could affect infection risk
- For patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus who had biologics withheld before surgery, these medications should only be restarted after wound healing is complete (typically ~14 days) 1
- Continue the usual daily dose of glucocorticoids for patients who were on them before surgery rather than administering supraphysiologic doses 1
Potential Risks and Benefits
Benefits
- Intra-articular corticosteroid injections can provide significant short-term pain relief 1
- May help improve function and mobility in the ankle joint while recovering from knee surgery
Risks
- Minimal risk of infection when proper aseptic technique is used and timing guidelines are followed
- Repeated injections may have potential long-term negative effects on bone health and joint structure 2
- Transient hyperglycemia in patients with diabetes
Decision Algorithm
Assess knee replacement wound healing:
- Complete wound closure achieved? (Yes/No)
- All sutures/staples removed? (Yes/No)
- Absence of swelling, erythema, drainage? (Yes/No)
- No signs of infection at surgical or other sites? (Yes/No)
If ALL answers are YES and at least 14 days have passed since surgery:
- Proceed with ankle cortisone injection using strict aseptic technique
If ANY answer is NO or less than 14 days since surgery:
- Delay injection until criteria are met
- Consider alternative pain management strategies in the interim
For patients on immunosuppressive medications:
- Follow specific guidelines for restarting biologics or other immunosuppressants
- Coordinate with the rheumatologist managing these medications
By following these guidelines, ankle cortisone injections can be safely administered after total knee replacement surgery while minimizing infection risk and maximizing therapeutic benefit.