From the Guidelines
Intraarticular corticosteroid injections after shoulder hemiarthroplasty with hardware are considered safe when used judiciously, but should be approached with caution, as evidenced by the lack of direct contraindications in recent guidelines 1. The primary concerns with these injections include potential acceleration of cartilage degeneration, increased risk of infection, and possible tendon weakening.
- Typical medications for these injections include methylprednisolone (40-80mg) or triamcinolone (20-40mg), often mixed with a local anesthetic like lidocaine.
- The presence of hardware itself is not a direct contraindication, as modern prosthetic materials are generally compatible with steroid preparations.
- However, if infection is suspected at all, cortisone should be avoided as it may mask symptoms or exacerbate an existing infection.
- Physical therapy and other conservative measures should be tried before resorting to injections, and persistent pain requiring multiple injections may indicate other issues that need surgical evaluation.
- The most recent guideline evidence suggests that intra-articular corticosteroids can reduce joint pain and improve function in OA-related pain, but the effects are time-limited and may have long-term negative effects on bone health, joint structure, and meniscal thickness associated with repeat administration 1.
- It is essential to weigh the benefits and risks of intra-articular corticosteroid injections in patients with shoulder hemiarthroplasty and hardware, considering the individual patient's condition and medical history.
- The decision to use intra-articular corticosteroid injections should be made on a case-by-case basis, taking into account the potential benefits and risks, as well as alternative treatment options.
From the Research
Safety of Intraarticular Corticosteroid Injection after Shoulder Hemiarthroplasty
- The safety of intraarticular corticosteroid (cortisone) injection after shoulder hemiarthroplasty with orthopedic hardware is a concern due to the potential risk of joint infection 2.
- Studies suggest that there is a high risk of infection at the first 4 weeks after the injection, but it seems that this risk declines to normal levels after that period 2.
- A delay of an arthroscopic intervention at any joint for at least 4 weeks is recommended to minimize the risk of postoperative infection 2.
Alternative Treatment Options
- Platelet-rich plasma (PRP) injections have emerged as an alternative therapy for adhesive capsulitis, with some studies showing better long-term outcomes compared to corticosteroid injections 3, 4.
- PRP injections may also be associated with a lower risk of postoperative infection in patients undergoing arthroscopy, representing a biologic alternative 2.
- Hyaluronic acid injections have also been shown to be effective in improving range of motion and alleviating pain in patients with shoulder capsulitis, with equivalent clinical outcomes compared to corticosteroid injections 5.
Considerations for Hemiarthroplasty
- Hemiarthroplasty and total shoulder replacement are two common treatment options for osteoarthritis, with total shoulder replacement showing advantages over hemiarthroplasty in terms of pain and function at 2 years 6.
- However, the use of intraarticular corticosteroid injections after hemiarthroplasty with orthopedic hardware is not directly addressed in these studies, and further research is needed to evaluate the safety and efficacy of this treatment option.