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

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. 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. 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, p = 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, p = 0.02) or one given between 3 and 12 months before arthroplasty (risk ratio 3.32; confidence interval 1.43–7.72, p = 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, p = 0.50). 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.