Does prior ipsilateral steroid injection affect outcomes after shoulder arthroplasty?

Background

Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA).

Methods

A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (<3 months, 3-12 months, and >12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score.

Results

421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; P < .001) and older age (75 vs. 70; P < .001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; P = .025) and abduction (70° vs. 60°; P = .004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (P = .009 and P = .007, respectively), and MCID for American Shoulder and Elbow Surgeons (P = .046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (P = .024). Complication and reoperation rates were comparable between groups.

Conclusion

Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications.