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

Sometimes, arthritis gets so bad that nothing seems to help, and people decide they are ready for joint replacement surgery. When that time comes, some patients are surprised to learn they will have to wait a few months because they recently had an injection of a steroid or hyaluronic acid. Waiting is not the only issue. The injections do little to relieve pain when someone has bone-on-bone arthritis and is a candidate for joint replacement. If there is any pain relief at all, it is very short-lived, and most patients are very disappointed.

The other issue is that patients who receive a steroid or hyaluronic acid injection should wait approximately three months from the date of their last injection to have a hip or knee replacement. This is because studies have demonstrated an increased risk of infection in the first three months following these injections. 


When elective surgeries resumed after the pandemic pause, I saw five patients over a two-week period whose joint replacement was delayed due to an injection. All were understandably upset that the physician who prescribed or gave them the injection did not inform them they would have to wait three months to have the surgery.

With respect to steroid injections in particular, there is another serious problem. Studies have shown that repeated shots of corticosteroids actually cause more destruction in the joint by accelerating damage to cartilage.

Hip and knee replacements are common and safe procedures that relieve pain and improve quality of life, and overall, the risk of developing an infection is very low. But since it is one of the most serious complications a patient can have after surgery, it is important to let enough time go by after an injection. As long a patient waits three months from their last injection, there is no increased risk at all.

Educated patients who take an active role in their care and ask good questions have the best chance to receive the right treatment for their condition.

 


Comments

Post a Comment

Popular posts from this blog

“Dual Mobility” Hip Replacement Does Double Duty: Relieves Pain and Reduces Risk of Dislocation

Image
Hip replacement to relieve arthritis pain is considered one of the most effective surgeries in the United States. Over the past decade, improvements in surgical technique, implant design, anesthesia and pain control after surgery have contributed to its success, says Geoffrey Westrich, MD, an orthopedic surgeon at Hospital for Special Surgery (HSS).  More than 450,000 total hip replacements are performed each year in the United States, according to the Agency for Healthcare Research and Quality. One of the most noteworthy advances is what’s known as a “dual mobility” hip replacement, according to Dr. Westrich, who has conducted several studies on the implant. He and colleagues have found that the dual mobility prosthesis reduces the risk of dislocation, one of the most common complications after hip replacement surgery. While the incidence is less than 2% at Hospital for Special Surgery and other major joint replacement centers, it is significantly higher at some other locations....
Read more

Did Halting In-Person Visits During Covid-19 Affect Knee Replacement Outcomes at Hospital for Special Surgery?

Image
At Hospital for Special Surgery (HSS), we set out to evaluate outcomes for recent knee replacement patients when nonessential in-person doctor visits and physical therapy were halted in March 2020 due to the pandemic. Our thought-provoking study found that the shutdown did not lead to a higher complication rate, nor did it affect patient-reported outcomes after surgery. Our study appeared online ahead of print in the Archives of Orthopaedic and Trauma Surgery . Elective, nonessential orthopedic care, including in-person office visits and physical therapy, was halted on March 16, 2020 at the onset of the COVID-19 surge in New York City. At that time, HSS rapidly expanded its telehealth and tele-rehabilitation services so patients could receive their care remotely, including post-operative visits and physical therapy.  Our study aimed to assess complications during the first 90 days following surgery and patient-reported outcomes within one year of surgery. We identified 624 patients...
Read more

Our Study at HSS Finds Knee Replacement with Robotic Assistance Leads to Lower Complication Rate

Image
These days you hear a lot about the use of robotics in joint replacement and other surgical procedures. Many orthopedic surgeons who perform robot-assisted surgery find that it improves the accuracy and predictability of a knee or hip replacement.  Indeed, the use of computer-assisted navigation and robotic assistance for total knee replacement has grown tremendously over the past few years and shows no sign of slowing down. Among American Association of Hip and Knee Surgeons attending the 2020 annual meeting, 77% of respondents indicated that they used technology in their surgical cases. The most common reason they cited was to increase surgical precision. A large study we undertook at Hospital for Special Surgery (HSS) found another major advantage of using a robot. Accessing and analyzing a huge national database with information on more than one million knee replacement patients, we found that surgery performed with robotic assistance led to a lower complication rate in the fir...
Read more