Infection Risk with Oral Steroids Following Hip Replacement

Risk Magnitude and Dose Relationship

Patients taking ≥15-20 mg/day of prednisone (or equivalent) have a significantly elevated risk of postoperative infectious complications, including periprosthetic joint infection (PJI) and surgical site infections 1, 2.
Meta-analyses demonstrate an odds ratio of 1.68 (95% CI 1.24-2.28) for postoperative infectious complications in patients on steroids, with an adjusted pooled OR of 1.7 (95% CI 1.38-2.09) 3.
Patients on lower doses (≤10-16 mg/day prednisone equivalent) have a lower but still present infection risk 2.

For elective hip replacement, corticosteroids should be stopped or minimized to the lowest possible dose prior to surgery, with complete cessation being ideal when medically feasible 1, 3.
If cessation is not possible, taper to <20 mg/day prednisone equivalent 1, 2.
The CDC defines the immunosuppression threshold at 20 mg/day for ≥2 weeks 2.

Continue the current daily dose perioperatively rather than administering supraphysiologic "stress doses" 2.
Provide intravenous hydrocortisone in equivalent dosage until oral intake resumes (prednisolone 5 mg = hydrocortisone 20 mg = methylprednisolone 4 mg) 1, 5.

Do not administer unnecessary stress-dose steroids to patients on chronic low-dose therapy, as this increases infection risk without hemodynamic benefit 2.
Avoid assuming all steroid-exposed patients have equal risk—dose and duration matter significantly 1, 2.