The safety of corticosteroid injection prior to shoulder arthroplasty: A systematic review.

Introduction: Intra-articular corticosteroid injections are frequently utilised in patients with glenohumeral arthritis for diagnostic and therapeutic purposes. A systematic review was performed to assess the relationship between prior corticosteroid injection and infection following shoulder arthroplasty.

Methods: A search was performed, using databases Medline, EMBASE and CINAHL. Studies with comparative data of post-arthroplasty infection following previous corticosteroid injection versus controls were included.

Results: Seven studies fulfilled the inclusion criteria, comprising 87,820 patients. On pooled analysis, previous steroid injection did not increase the overall risk of infection (risk ratio 1.17; confidence interval 1.00-1.37,  = 0.06). On subgroup analysis for timing of injection, one given within 3 months before arthroplasty conferred a greater risk of infection than no injection (risk ratio 2.30; confidence interval 1.13-4.69,  = 0.02) or one given between 3 and 12 months before arthroplasty (risk ratio 3.32; confidence interval 1.43-7.72,  = 0.005). An injection at 3 to 12 months before arthroplasty did not increase the risk of infection over controls (risk ratio 0.89; confidence interval 0.63-1.25,  = 0.50).

Conclusions: This review has found there to be a time-dependent relationship between prior corticosteroid injection and infection post-arthroplasty, with an increased risk when performed within three months before arthroplasty. Thus, an interval of at least three months is recommended between injection and arthroplasty.