Cortisone Injections in Total Knee Replacements

Indications and Contraindications

The European League Against Rheumatism (EULAR) guidelines state that intra-articular glucocorticoid injections in prosthetic joints should be avoided in routine practice and only considered after strict screening for prosthetic infection in consultation with the orthopedic surgical team 1, 2
Cortisone injections into a prosthetic knee should only be performed after rigorous exclusion of prosthetic joint infection and direct consultation with the orthopedic surgeon who performed the replacement 1, 2
The infection risk following cortisone injection into a prosthetic knee is 0.6% (1 in every 625 injections) based on a large retrospective review of 1,845 injections in 736 patients with total knee prostheses 1, 2

Diabetic patients require specific counseling to monitor glucose levels closely for 1-3 days post-injection due to transient hyperglycemia risk 1, 2
The risk of transient hyperglycemia is highest in patients with suboptimal glycemic control 1, 2

Patients should be advised to avoid overuse of the injected joint for 24 hours, but immobilization is discouraged 1
Normal activity after 24 hours is appropriate 1

Aseptic technique is mandatory with surgical gloves, skin preparation with alcohol or chlorhexidine, and consideration of changing needles between drawing and injecting 2