From the Guidelines
It is recommended to wait at least 3 months after carpometacarpal (CMC) joint corticosteroid injection before undergoing CMC arthroplasty. This recommendation is based on the evidence from a high-quality study published in the Annals of the Rheumatic Diseases in 2021 1. The study suggests that intra-articular therapies, including corticosteroid injections, may be performed at least 3 months prior to joint replacement surgery, and that the risk of infection with IA GC injection in the hip or knee prior to total joint arthroplasty is not conclusive, but may be higher if the injections are performed within 3 months of surgery.
Key Considerations
- The waiting period is important to minimize the risk of post-operative infection and to allow for optimal tissue healing.
- Corticosteroid injections can suppress the local immune response and alter the tissue environment, which could compromise surgical outcomes if surgery is performed too soon after injection.
- Some surgeons may prefer to wait even longer, up to 6 months, particularly if there have been multiple injections or if there are other risk factors for surgical complications.
- The exact timing may vary based on individual patient factors, the surgeon's preference, and institutional protocols, so it's essential to discuss this timing with your orthopedic surgeon during surgical planning.
Evidence Summary
- A recent study published in 2021 found that the rate of prosthetic infections 3 months after surgery was significantly larger in the groups that had injections 0–3 months prior to total hip or knee arthroplasty, but not if the injections were separated from the surgery longer than 3 months 1.
- The study also found that the risk of septic arthritis following intra-articular corticosteroid injection is very low, but may be higher than previously thought, with a current risk estimate of 0.035% 1.
From the Research
Recommended Waiting Period After CMC Joint Corticosteroid Injection
- The recommended waiting period after carpometacarpal (CMC) joint corticosteroid injection before undergoing CMC arthroplasty is at least 3 months, as supported by studies 2, 3.
- A study published in The Journal of Hand Surgery found that patients who received an intra-articular corticosteroid injection within 3 months before surgery had a 2.2 times greater likelihood of repeat surgery for a wound complication/infection compared to patients who did not have an injection within 6 months before surgery 2.
- A meta-analysis published in Clinical Orthopaedics and Related Research found that intra-articular corticosteroid injections within 3 months before arthroplasty were associated with an increased risk of periprosthetic joint infection during subsequent joint arthroplasty, and recommended against performing total joint arthroplasty on a patient who has received an intra-articular corticosteroid injection within 3 months 3.
Considerations for CMC Arthroplasty
- The decision to undergo CMC arthroplasty should be made on a case-by-case basis, taking into account the patient's specific needs and medical history 4.
- Other studies have focused on the effectiveness of corticosteroid injections for thumb CMC joint arthritis, including the use of image-guided injections 5, 6, but these do not directly address the recommended waiting period before arthroplasty.