Optimal Timing of CMC Arthroplasty After Corticosteroid Injection

Evidence‑Based Infection Risk

EULAR guideline recommends waiting at least 3 months after an intra‑articular glucocorticoid injection before performing any total joint arthroplasty (including CMC arthroplasty) because injections given 0–3 months pre‑operatively double the prosthetic infection rate (approximately 0.5 % → 1.0 %) compared with the background risk (≈ 1.0 %–2.5 %). Injections performed > 3 months before surgery do not increase infection risk. Strength of evidence: guideline recommendation based on large‑joint arthroplasty data. 1
The same EULAR evidence indicates that extending the interval beyond 3 months provides no additional protective benefit against infection, supporting a 3‑month cutoff as the optimal balance between safety and timely surgery. Strength of evidence: guideline recommendation. 2

Both the injection and the subsequent CMC arthroplasty must be performed using strict aseptic technique (sterile gloves, chlorhexidine or alcohol skin preparation, and full sterile protocols) to minimize infection risk. Strength of evidence: guideline recommendation. 1

Patients with diabetes should receive counseling to monitor blood glucose for 1–3 days after any corticosteroid injection because of the transient hyperglycaemia risk associated with glucocorticoids. Strength of evidence: guideline recommendation. 2

> 3 months after injection – Proceed with CMC arthroplasty; infection risk is not increased. Evidence: EULAR guideline. 1
≤ 3 months after injection – Delay surgery until the 3‑month interval is completed to avoid the documented increase in infection and re‑operation risk. Evidence: EULAR guideline. 2