Is it safe to receive a knee steroid injection one week after undergoing a reverse shoulder arthroplasty?

Safety of Knee Steroid Injection Following Recent Reverse Shoulder Arthroplasty

A knee steroid injection should be delayed until at least 4 weeks after a reverse shoulder arthroplasty to minimize infection risk.

Infection Risk Considerations

Timing of Steroid Injections

• Corticosteroid injections performed within 4 weeks of shoulder arthroplasty are associated with significantly increased risk of periprosthetic joint infection (PJI) 1
• Research specifically on reverse shoulder arthroplasty (RSA) demonstrates that injections within 1 month prior to surgery increase PJI risk at both 90 days and 1 year postoperatively 1
• The risk pattern appears similar for postoperative injections, with significantly higher infection rates when corticosteroid injections are administered within 1 month after shoulder arthroscopic procedures 2

Evidence from Other Joint Procedures

• For knee arthroplasty, injections within 2-4 weeks before surgery show increased infection risk, with injections within 2 weeks carrying the highest risk (odds ratio: 2.89) 3
• European League Against Rheumatism (EULAR) guidelines recommend that intra-articular therapy should be performed at least 3 months prior to joint replacement surgery 4
• The VA/DoD clinical practice guidelines specifically note that corticosteroid injections should be avoided for 3 months preceding joint replacement surgery 4

Systemic Effects and Cross-Joint Considerations

• While the evidence primarily focuses on same-joint injections and surgery, there are several important considerations for cross-joint procedures:
  • Corticosteroid injections can cause systemic immunosuppressive effects that may affect healing at distant surgical sites 4
  • Patients with rheumatoid arthritis have a significantly higher risk (9% vs 3%) of developing postoperative infections after reverse shoulder arthroplasty 5
  • The early postoperative period (first month) represents a critical healing time when immunosuppression from any source could potentially compromise surgical outcomes 1, 2

Recommended Approach

• Wait at least 4 weeks after reverse shoulder arthroplasty before administering a knee steroid injection 1, 6
• After 4 weeks post-surgery, the infection risk appears to normalize to baseline levels, assuming normal wound healing has occurred 1, 2
• Ensure that the surgical wound from the shoulder arthroplasty shows evidence of complete healing with no signs of infection before proceeding with any steroid injection 4

Special Considerations

• For patients with diabetes, monitor blood glucose levels for 1-3 days after injection as intra-articular steroids can cause transient hyperglycemia 4
• If the knee injection is urgently needed for symptom control, consider alternative pain management strategies during the first 4 weeks post-arthroplasty 4
• When the knee injection is performed, use strict aseptic technique to minimize infection risk 4

Common Pitfalls to Avoid

• Avoid assuming that injections in a different joint (knee vs. shoulder) carry no risk to the surgical site 4
• Do not underestimate the systemic immunosuppressive effects of corticosteroids, even when administered locally 4
• Remember that the first month after arthroplasty represents a critical healing period when additional immunosuppression should be avoided when possible 1, 2