Have you had a joint replacement, perhaps hip or knee, but are still experiencing pain?
Are you considering a steroid injection for your pain, and wonder whether it safe to do so?
As to whether you can have a steroid injection after a joint has been replaced, the short answer is ‘no’!
A steroid injection into a replaced joint is considered a contraindication. This means that is it strongly recommended that they are not carried out. The main reasons for this are the increased risk of infection after the injection and that the steroid will stop the body’s normal healing response.
Steroid (also known as cortisone or corticosteroid) is a powerful anti-inflammatory medication that is commonly used to reduce pain and inflammation in many conditions. Although, corticosteroids are very effective at reducing pain there are certain situations where corticosteroids should be avoided, and joint replacement surgery is one of them.
Also worth noting is that if you are due to undergo joint replacement surgery within 3 months, you will need to get approval from your consultant before we can give you a steroid injection into that joint.
Risk of joint infection
The risk of a joint infection occurring following a steroid injection into a replaced joint is somewhat increased, due to the immunosuppressive effects of the steroid medication. Immunosuppression means a reduction in your body’s ability to fight infections.
Joint infection is a very rare (1:100,000) side effect from a steroid injection into a non-replaced joint, but recent medical evidence has shown that the infection risk does increase slightly to 2.1% following a steroid injection directly into a replaced joint and it was concluded they should be avoided (Cheppalli et al., 2021).
The main issue if you get an infection in the joint is that it will compromise the replacement. There is also the possibility of the infection spreading to other parts of your body, or in worst cases it can sometimes cause septicaemia. It is therefore concluded that the risks outweigh the benefits of pain relief from the steroid injection..
An impaired healing process
Corticosteroids impair the healing process. The primary goal of joint replacement surgery is to replace the damaged joint with a prosthetic/metal joint which can function like its natural counterpart. After surgery, the body undergoes a complex process of tissue healing and bone remodelling to accommodate the new joint.
It is, therefore, essential that the healing process is allowed to continue without interference. An effective healing process is dependent on a healthy immune system and therefore, to avoid a delayed or incomplete healing process, the introduction of steroid/corticosteroids should be avoided.
Can you carry out a steroid injection near a replaced joint?
As a general rule we would avoid injecting steroid anywhere need the replaced joint. We do receive occasional referrals from surgeons following a hip replacement. These are normally for an ultrasound guided steroid injection into the outside of the hip, into the region called the trochanteric bursa. This can provide rapid pain relief if pain following a hip replacement continues and your consultant suggests this may be a potential source of your pain.
We would only carry this out if you have been referred by your surgeon who carried out the replacement.
If you would like to discuss your specific case before making an appointment, please contact 0207 482 3875 or email info@complete-physio.co.uk and one of our expert clinicians will call you back.
What other pain control options are available if you cannot have a steroid injection?
Joint replacement surgery is a major operation which involves significant trauma to the bones and soft tissues of the joint. Following a knee or hip replacement it is not uncommon to have pain in the joint, this can last for up to one year after the operation.
The majority of patients’ pain will settle in this time frame with physiotherapy and modification of activity. However, if you are getting continued pain from your joint replacement, you should discuss this with your surgeon and/or physiotherapist.
At Complete Physio we are experts in the post-operative care and rehabilitation of knee and hip replacements. Every year we help lots of patients get back to full function after their surgery, whether it is walking, cycling, skiing or playing golf.
At Complete, we would recommend the following to help get you out of pain and back to full function:
- Modification of daily activities to avoid flare-ups.
- Taking regular breaks from activities.
- Keep an eye on your step count to monitor how much walking you are doing and ensure you gently increase your activity.
- Using ice if your joint feels hot and swollen.
- Using heat if your joint feels achy.
- Liaise with your GP, surgeon or pharmacist about using over the counter pain relief or prescription painkillers. This will help you get the most from your rehabilitation programme.
- Gentle stretches – to mobilise the hip and knee can help to reduce pain and improve your range of movement following a replacement.
- Strengthening exercises – specifically for the surrounding muscles of the knee and hip such as the quadriceps, hamstrings and gluteal muscles. This not only helps with controlling the pain but will also help you recover quicker after your surgery.
- Don’t be afraid to have rest/recovery days where you put your feet up and take it easy!
In summary, while steroid injections can be highly effective in reducing pain and inflammation, they should be avoided following joint replacement surgery. Patients who have had joint replacement surgery should discuss their pain management options with their physiotherapist and/or orthopaedic consultant, who can help determine the best course of treatment for their individual needs.
If you would like to discuss how physiotherapy could help, please contact 0207 482 3875 or email info@complete-physio.co.uk and one of our expert clinicians will call you back.