Safety of Knee Steroid Injection Following Recent Reverse Shoulder Arthroplasty

Infection Risk Considerations

The European League Against Rheumatism (EULAR) guidelines recommend that intra-articular therapy should be performed at least 3 months prior to joint replacement surgery, to minimize infection risk 1, 2
The VA/DoD clinical practice guidelines specifically note that corticosteroid injections should be avoided for 3 months preceding joint replacement surgery, due to increased infection risk 3

Corticosteroid injections can cause systemic immunosuppressive effects that may affect healing at distant surgical sites, including increased risk of postoperative infections 4, 5

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, to minimize infection risk 5, 6

For patients with diabetes, monitor blood glucose levels for 1-3 days after injection as intra-articular steroids can cause transient hyperglycemia, according to the European League Against Rheumatism (EULAR) guidelines 1, 7
If the knee injection is urgently needed for symptom control, consider alternative pain management strategies during the first 4 weeks post-arthroplasty, as recommended by the VA/DoD clinical practice guidelines 3
When the knee injection is performed, use strict aseptic technique to minimize infection risk, as recommended by the European League Against Rheumatism (EULAR) guidelines 1

Avoid assuming that injections in a different joint (knee vs. shoulder) carry no risk to the surgical site, as corticosteroid injections can cause systemic immunosuppressive effects 4, 5
Do not underestimate the systemic immunosuppressive effects of corticosteroids, even when administered locally, as they may affect healing at distant surgical sites 4, 5