Cortisone Injections and Knee Surgery
In the context of knee health and surgery, cortisone injections play a significant role. Understanding these injections and the implications they have on knee surgery is essential for anyone considering this treatment route.
Understanding Cortisone Shots
Cortisone shots, also known as corticosteroid injections, are a common nonsurgical treatment for knee pain. They are often used to alleviate the symptoms of a variety of conditions, such as osteoarthritis, rheumatoid arthritis, and other inflammatory diseases.
These injections work by reducing inflammation in the knee joint, thereby providing temporary relief from pain and swelling. Although cortisone injections can be an effective treatment option, they are not without risks and potential side effects.
Risks of Cortisone Before Knee Surgery
When planning a total knee arthroplasty (TKA), or knee replacement surgery, the timing of cortisone injections can significantly impact the risk of postoperative infection. According to a study published on PubMed, corticosteroid injections within two weeks before TKA increased the risk of postoperative infection. The same study found that injections within 2 to 4 weeks also showed a trend towards increased infection risk in univariate regression.
These findings were further confirmed by another study cited by NCBI, which found a significant association between intra-articular knee corticosteroid injections within four weeks of surgery and an increased incidence of postoperative infection.
In addition, the study conducted on 76,090 TKA patients from 2007 to 2017 found that corticosteroid injections within two weeks before TKA increased the risk of postoperative infection, with an odds ratio of 2.89.
Therefore, the question of how long to wait for knee surgery after a cortisone shot is crucial to minimize postoperative complications. Both studies suggest a waiting period of at least four weeks after a corticosteroid injection before undergoing knee surgery. However, further research is needed to determine the optimal timing for surgery to ensure the highest safety and efficacy.
Timing Considerations
Determining the optimal timing for knee surgery after a cortisone shot is crucial in ensuring the success of the procedure and minimizing potential risks.
Optimal Timing for Knee Surgery
In a study conducted from 2007 to 2017 on 76,090 total knee arthroplasty (TKA) patients, it was found that delaying surgery for more than four weeks after a corticosteroid injection may not provide additional reduction in infection risk after TKA PubMed. However, the same study also noted that corticosteroid injections within 2 weeks before TKA increased the risk of postoperative infection. Thus, it's essential to plan the timing of the surgery carefully.
| Time of Injection Before TKA |
Infection Risk |
| Within 2 weeks |
Increased |
| 2 to 4 weeks |
No significant increase |
| More than 4 weeks |
No significant increase |
Effects of Cortisone Injections
Corticosteroid injections are known to provide temporary relief from knee pain and inflammation. However, studies have linked these injections to an increased risk of postoperative infection when administered too close to the surgery date.
In a study of 76,970 patients undergoing total knee arthroplasty, injections within 2 weeks of surgery had an increased infection risk of 3.1%, injections between 2-4 weeks had a nonsignificant increased risk of 1.21%, and all other groups beyond 4 weeks had no difference in infection rate.
| Time of Injection Before TKA |
Infection Risk |
| Within 2 weeks |
3.1% |
| 2 to 4 weeks |
1.21% |
| More than 4 weeks |
No significant increase |
These findings suggest that the timing of cortisone shots in relation to knee surgery plays a significant role in the risk of postoperative infection. Therefore, it's crucial to consult with a healthcare provider to plan the best course of action tailored to each individual's needs and health status.
Postoperative Infection Risk
When contemplating knee surgery after a cortisone shot, it is essential to consider the potential risk of postoperative infection. Various factors can influence this risk, including the timing of the cortisone shot in relation to the surgery.
Factors Influencing Infection Risk
Several factors can influence the risk of postoperative infection after total knee arthroplasty (TKA). These include the patient's health status, lifestyle habits, and the timing and frequency of cortisone injections. According to the Mayo Clinic, doctors typically limit the number of cortisone shots into a joint due to concerns about potential damage to the cartilage within the joint.
Risk factors associated with postoperative infection after TKA include chronic obstructive pulmonary disease, coronary artery disease, diabetes, ischemic heart disease, obesity, rheumatoid arthritis, and tobacco use. On the other hand, female sex and patients aged older than 65 were found to have protective effects against postoperative infection following TKA.
Study Findings on Infection Rates
A study conducted from 2007 to 2017 on 76,090 TKA patients found that corticosteroid injections within 2 weeks before TKA increased the risk of postoperative infection, with an odds ratio of 2.89. Injections within 2 to 4 weeks also showed a trend towards increased infection risk in univariate regression. However, there were no significant differences observed in postoperative infection risk for TKA patients who received corticosteroid injections at time frames other than within 2 weeks before surgery.
Additionally, delaying surgery more than four weeks after a corticosteroid injection may not provide additional infection risk reduction. Further prospective randomized studies are recommended to determine the optimal timing of TKA after corticosteroid injections.
Overall, while corticosteroid injections can provide temporary relief from knee pain, it is crucial to consider the potential risk of postoperative infection when deciding how long to wait for knee surgery after a cortisone shot. Patients should discuss these risks and considerations with their healthcare provider to make an informed decision.
Recovery Recommendations
When considering the question of 'how long to wait for knee surgery after cortisone shot', it's crucial to understand the importance of recovery following the cortisone injection, before any surgery is undertaken. Here, we discuss the typical rest periods after a cortisone shot, and when one can resume activity post-injection.
Rest Period After Cortisone Shot
The duration of the rest period after a cortisone shot can vary based on the individual's overall health and the specific joint that received the injection. As a general guideline, it's typically advised that otherwise healthy patients rest for at least 24 hours following a cortisone injection. This rest period may need to be extended for patients who are older or have multiple health conditions.
| Joint Injected |
Recommended Rest Period |
| Knee |
24 - 48 hours |
| Shoulder |
Seven days |
| Hip |
Seven days |
Information courtesy of HSSH Health
Resuming Activity Post-Injection
Resuming activity after a cortisone injection should be a gradual process. For a knee cortisone injection, it's recommended to rest for at least 24-48 hours and then resume slow, gentle walking for short distances. This allows the knee joint to recover while also promoting circulation and flexibility.
For cortisone injections in the shoulder or hip, it's generally advised to limit all types of activity for around seven days. During this time, patients should avoid moderate or strenuous lifting (shoulder) and wait until advised by a physiotherapist before resuming normal activity (hip).
To maximize the effectiveness of cortisone shots, patients are usually advised to rest the affected joint for about a week following the injection [4]. The type of cortisone used can impact how long the relief lasts, with short and long-acting preparations available. Therefore, patients should always follow their healthcare provider's instructions and inquire about the type of cortisone used in their specific treatment.
Cortisone Shot Effectiveness
When considering the timeframe of knee surgery after a cortisone shot, it's important to understand the typical duration of cortisone effects and the impact of repeated injections on the knee.
Duration of Cortisone Effects
Relief from a cortisone injection can begin anytime within a few days to a few weeks after the injection. Once relief begins, it should last between four and six weeks. However, it's important to note that the effectiveness of the cortisone shot can vary from person to person. Studies have shown that steroid injections typically last somewhere between a few weeks and a few months, depending on an individual's response to the cortisone shot [5].
In many cases, patients report feeling significant relief from knee pain and can return to sport within a month after a cortisone injection. However, it can take up to a week for a cortisone shot to take full effect. Patients are encouraged to communicate with their provider if it's been more than 10 days and they don't feel better.
Repeated Cortisone Injections
While some patients might only need one cortisone shot to relieve pain and inflammation, especially those recovering from a temporary injury, others might require repeated treatments. Chronic conditions like arthritis of the knee often necessitate more steroid injections in the future. However, it's recommended that there be a gap of at least three months between shots to prevent any potential adverse effects [5].
It's crucial for patients and physicians to monitor the effectiveness and impact of cortisone shots closely. This will help determine the optimal timing and frequency of injections, and how long to wait for knee surgery after a cortisone shot, ensuring the best possible patient outcomes.
Monitoring and Safety
While cortisone injections can be a beneficial treatment for knee pain relief, it's crucial to understand the frequency of these injections and how to monitor for potential side effects. This knowledge will help individuals manage their knee condition effectively and ensure safety during the treatment process.
Frequency of Cortisone Injections
Cortisone injections can provide pain relief for several weeks up to a few months [6]. As the effects gradually wear off, it may be necessary to repeat the cortisone shot. However, there are limits to how often these injections can be administered.
Generally, cortisone shots can be taken around every six weeks, but not more than three to four times a year. Shots are typically limited to once every three months for specific joints and up to four times a year for the entire body.
Most healthcare providers suggest that individuals should not have more than three cortisone shots in a year. The exact timing of when it's safe to receive another dose is determined based on the individual's condition.
Side Effects and Monitoring
While cortisone injections are generally safe, there are some rare side effects to be aware of. These can include weakened tendons in the treated area and reduced blood flow to the bone. These side effects are more likely to occur when cortisone is used more often than three or four times a year in one joint.
Healthcare providers monitor for these side effects and adjust treatment frequency if needed to prevent them. It's crucial for individuals receiving cortisone injections to communicate any changes in their symptoms or new discomfort to their healthcare provider promptly. Regular monitoring and open communication can help ensure the safety and effectiveness of cortisone injections as a treatment for knee pain.
In sum, when considering how long to wait for knee surgery after a cortisone shot, it's important to factor in the frequency of injections and potential side effects. This understanding will help individuals and their healthcare providers make informed decisions about their treatment plan.
References
[1]: https://pubmed.ncbi.nlm.nih.gov/33229905/
[2]: https://icmphilly.com/2021/09/07/paper-of-the-week-do-we-need-to-wait-3-months-after-corticosteroid-injections-to-reduce-the-risk-of-infection-after-total-knee-arthroplasty/
[3]: https://hssh.health/blog/do-you-need-to-rest-after-a-cortisone-injection/
[4]: https://vanguardspine.com/blog/how-long-does-a-cortisone-shot-last/
[5]: https://my.clevelandclinic.org/health/treatments/cortisone-shots-steroid-injections
[6]: https://www.gomberamd.com/blog/cortisone-injections-33888.html
