Steroids and THA/TKA/TSA

[clubdeac]

So now all the orthopod's here are telling patients they can't have a THA, TKA or total shoulder within 6 months of a steroid injection ANYWHERE in their body. Anyone else seeing this?! Is there some new stduy out there that I'm not aware of? Seems like overkill

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[lobelsteve]

3mo in the joint to be replaced, hgba1c less than 7.5, prefer 7.

 

[Taus]

I'm in a very large ortho group and frequently see 3 months in the joint to be replaced.... nothing to do with steroids in other areas of the body.


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[melancholy]

There was an ortho study that got published this year on knee steroid injections before TKR and found no increased complication rates for infection for injections within 3 months prior to surgery. Not sure of what other literature out there says. Surgeons around me don't want any injecting of anything around the joint to be replaced for about 2-3 months prior. I have not heard anything about injections in other parts of the body. (i.e. shoulder injection or even trigger point injection with steroid).

 

[Dr. Ice]

There was an ortho study that got published this year on knee steroid injections before TKR and found no increased complication rates for infection for injections within 3 months prior to surgery. Not sure of what other literature out there says. Surgeons around me don't want any injecting of anything around the joint to be replaced for about 2-3 months prior. I have not heard anything about injections in other parts of the body. (i.e. shoulder injection or even trigger point injection with steroid).

This is correct. No joint replacement within 90 days of cs administration. No issue with visco or steroid in other parts of body

 

[Tapspatellas]

Most of our ortho are 3 months for the joint, don't care about the other areas. Have one guy who doesn't care either way, and another who doesn't want steroids anywhere within 6 weeks, which seems a bit arbitrary.

 

[Timeoutofmind]

Most of our ortho are 3 months for the joint, don't care about the other areas. Have one guy who doesn't care either way, and another who doesn't want steroids anywhere within 6 weeks, which seems a bit arbitrary.

What about ESIs before spine surgery... also 3 months?...they went over the data at SIS this year. Very conflicting and controversial.

 

[nvrsumr]

There was an ortho study that got published this year on knee steroid injections before TKR and found no increased complication rates for infection for injections within 3 months prior to surgery. Not sure of what other literature out there says. Surgeons around me don't want any injecting of anything around the joint to be replaced for about 2-3 months prior. I have not heard anything about injections in other parts of the body. (i.e. shoulder injection or even trigger point injection with steroid).

Any chance you can post this article? Thanks!

 

[melancholy]

Any chance you can post this article? Thanks!

Here's the article I was referring to:

Intra-Articular Knee Injections Before Total Knee Arthroplasty: Outcomes and Complication Rates. - PubMed - NCBI

I did run across another article I had forgotten about that came out earlier this year which was another review of the topic. They concluded that there was increased risk for infection or need for surgery for those w steroid injection within 6 months of TKR.

The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA? - PubMed - NCBI


Source of data are different so make your own conclusions.




If anyone happens to be curious about rates of complications or infections for post-TKR knees that get periarticular steroid injections (if looking at other sources of residual pain), this is all I have ever found.

Results of peri-articular steroid injection in the treatment of chronic extra-articular pain after total knee arthroplasty. - PubMed - NCBI



The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA? - PubMed - NCBI




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[Tapspatellas]

What about ESIs before spine surgery... also 3 months?...they went over the data at SIS this year. Very conflicting and controversial.

Yes I was hoping for a little more clear cut answer, but left it muddy. One of my surgeons sent me the latter article they discussed and asked if I had seen it, so they are paying attention. They still are not implementing anything related to it, but I can't say that won't change.