A Steroid Injection for Bone-on-Bone Arthritis? Not So Fast


When elective surgeries resumed in New York City in June, it was a relief for patients with severe hip or knee arthritis who had made up their minds to have joint replacement surgery. Many people needed to wait when the procedures, considered elective, were put on hold due to the pandemic. Some patients were in so much pain, they wanted to have the procedure as soon as possible.

But a number of them were surprised to learn they would have to wait, in some cases up to three months, because they had received an injection of a steroid or hyaluronic acid in their joint at another doctor’s office.

There are two issues for patients. First, the injections do nothing to relieve pain when someone has bone-on-bone arthritis and is a candidate for joint replacement, or if they provide any pain relief at all, it is very short lived. The other problem is that anyone who has received a steroid or hyaluronic acid injection must then wait approximately three months from the date of their last injection to have hip or knee replacement surgery. This is because studies have demonstrated an increased risk of infection in the first three months following these injections.
 

I saw five patients over a two-week period whose joint replacement needed to be delayed due to an injection. All were understandably upset that the physician who ordered or gave them the injection did not inform them they would to wait three months to have a joint replacement. Two patients were in tears.

Hip and knee replacements are common and safe procedures that relieve pain and greatly improve quality of life. Overall, the risk of developing a joint infection is very low, but it is one of the most serious complications a patient can have following surgery. Studies show that as long as patients wait three months after receiving an injection, there is no increased risk at all.

An educated patient who takes an active role in his or her care and asks the physician good questions has the best chance to receive the right treatment for his or her condition.  

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