Timing of CMC Arthroplasty After Steroid Injection
Wait at least 3 months after a corticosteroid injection into the carpometacarpal joint before performing CMC arthroplasty to minimize the risk of postoperative infection and reoperation.
Evidence-Based Timing Recommendation
The optimal waiting period is based on extrapolation from large joint arthroplasty data and specific CMC joint research:
The 3-month threshold is supported by EULAR guidelines, which demonstrate that intra-articular glucocorticoid injections performed 0-3 months before total joint arthroplasty significantly increase prosthetic infection rates (from 0.5% to 1.0% versus background risk of 1.04% to 2.5%), while injections separated from surgery by more than 3 months show no significant increase in infection risk 1.
CMC-specific data confirms increased reoperation risk within 3 months: A large database study of 5,046 CMC surgery patients found that those receiving corticosteroid injections within 3 months before surgery had 2.2 times greater likelihood of requiring repeat surgery for wound complications/infection compared to patients without injections within 6 months 2.
Key Clinical Considerations
Infection and Complication Risks
The overall wound complication/infection rates within 90 days after CMC surgery are similar regardless of injection timing, but the severity requiring reoperation is significantly higher when injections occur within the 3-month window 2.
Minor complication rates are elevated in patients who received any preoperative injections (16.4% vs 9.2% in injection-naïve patients), though major complication rates remain comparable 3.
Functional Outcomes Are Not Affected
Preoperative steroid injection status does not impact functional outcomes measured by Quick DASH scores at 5 or 11 months postoperatively, whether patients received 1 injection or more than 3 injections 3.
The number of preoperative injections does not correlate with worse surgical outcomes, so multiple prior injections should not be considered a contraindication to surgery 3.
Practical Algorithm for Surgical Timing
If injection was given:
- < 2 weeks ago: Highest risk period; delay surgery if possible beyond 3 months 4
- 2-4 weeks ago: Elevated risk period; strongly consider delaying to 3 months 4
- 1-3 months ago: Moderate increased risk; delay to complete 3-month interval 2
- > 3 months ago: Proceed with surgery; no increased infection risk 1, 2
If no injection within 6 months: Proceed with surgery without additional precautions related to injection timing 2.
Important Caveats
Aseptic technique is mandatory during both injection and surgery, using surgical gloves, chlorhexidine or alcohol skin preparation, and strict sterile protocols 1.
Diabetic patients require special counseling to monitor glucose levels for 1-3 days after any corticosteroid injection due to transient hyperglycemia risk 1.
The 3-month waiting period represents a balance between infection risk reduction and avoiding unnecessary surgical delay, as waiting beyond 3 months provides no additional protective benefit 1.
Image-guided versus non-image-guided injections do not significantly affect the time to eventual surgery (333.7 days vs 317.7 days), so injection technique does not alter surgical timing recommendations 5.