Injections before joint replacement may lead to infection

Joint replacement surgery is a common treatment for severe joint arthritis. The most common type of joint replacement is knee replacement surgery, closely followed by hip replacement surgery. Generally, these surgical procedures are reserved for patients with severe arthritis who have failed extensive attempts at non-surgical treatment.

A more common non-surgical treatment for people with arthritis is injections into the joints. The most commonly used injections are steroids. Another type of injection is called a viscous supplement, which is an option for knee arthritis. Research has examined whether these injections can be safely given before planned joint replacements.

Shooting Risk Before Replacement

The researchers looked at a large database of Medicare patients who had knee replacement surgery. They were able to compare patients who were injected with cortisone or mucus supplements before joint replacement, and whether the individual had an infection after surgery. The data clearly showed that people who had injections before surgery had a higher chance of infection.

In addition, the study found that the risk of infection after surgery was closely related to how long before surgery patients received their most recent injection. The risk of complications increases significantly if injections are given within 7 months of surgery. There was little difference in the risk of infection after surgery if the injection was given to the joint more than seven months before surgery. Therefore, 7 months can be used as a guide, and patients may be told to avoid injections into the joint for 7 months prior to elective joint replacement surgery. However, individual surgeons may have different approaches to this.

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Exactly why injections into the joints may increase the chance of infection months later is not fully understood. One possibility is that the drug may reduce the body’s ability to fight off infectious bacteria. Whatever the mechanism, before elective joint replacement surgery, there does seem to be a time when people should be very cautious about anything put into their joints. In addition, while the data is based on surveys of knee replacements, one should be cautious about injecting any joint that will be replaced.

Therefore, people who may be undergoing hip, shoulder or ankle replacement surgery should also avoid injections if they are about to have joint replacement surgery. The study did not show any evidence that injecting into another joint rather than the one being replaced is harmful. For example, there is currently no evidence that a left knee injection before a right knee replacement is a bad thing.

infection after replacement

Infection is a particularly worrying complication of joint replacement surgery. Infections often require additional surgery, or sometimes multiple surgeries. In addition, people with infections after joint replacement tend to have the same hip and knee function as people without these complications. Also, in the worst case, the infection can lead to a serious systemic infection.

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Signs of joint replacement infection include increased discomfort, fever and chills, redness near the surgical site, and drainage around the incision. Anyone who has recently had a joint replacement and shows these signs should be carefully evaluated by their surgeon. When infection is detected early, treatment may be less invasive. However, when the infection bypasses the joint implant (deep infection), treatment is almost always one or more surgical procedures.

Bottom line: Is it safe to shoot?

The research was clear: At least seven months passed between the time the knee was injected and the elective knee replacement surgery in which the joint was injected. Surgery on that knee within seven months of the injection could put you at a higher risk of infection. Avoiding infection is very important and every step should be taken to prevent this potentially serious complication. While this study focused on knee injections and knee replacements, people replacing other joints should be equally cautious and discuss the pros and cons of any injection with their surgeon.

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Frequently Asked Questions

  • What is the needle size for knee injections?

    For knee osteoarthritis, one guideline recommends using a 22-gauge needle between 1.5 inches and 3.5 inches in length. Needles used for knee injections may not always be the same size.

  • Can Zilretta injections cause joint infections?

    Infections can occur with any type of injection, but are less likely to occur when administered by a healthcare professional. A study of a group of patients with knee osteoarthritis showed that none of them developed joint infections as a result of injections.

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