Knee replacements are a standard orthopaedic procedure to treat knee arthritis. While 80% of patients with a knee replacement report good results, about 15-20% struggle with ongoing pain after a knee replacement. We use steroid injections to treat pain and inflammation from knee arthritis. Can you receive a cortisone injection after a knee replacement to treat post-surgical knee pain? What are the risks of steroid injections after a knee replacement?
What is Cortisone?
Cortisone is a powerful anti-inflammatory medication. When injected directly into the joint, cortisone can reduce inflammation and alleviate pain. This makes it a valuable tool for managing joint-related conditions, including arthritis, bursitis, and tendonitis.
Cortisone Injections After Knee Replacement: Increased Risk of Infection
Not only does cortisone reduce inflammation, but it also has a powerful effect on suppressing the immune system. We think this effect on the immune system increases the risk of infection. Cortisone also impairs tissue healing, making the knee replacement more vulnerable
Performing a cortisone injection in a knee replacement can introduce bacteria into the joint. The risk of infection increases when combined with the adverse effects of cortisone, such as immune suppression and impaired healing. An infected knee replacement can be severe, often necessitating prolonged antibiotic treatment and additional surgeries.
- A cortisone injection after a knee replacement is a high-risk procedure.
- The risk of infection increases by over 50% after a cortisone injection.
- We don’t know how effective a cortisone injeciton is after a knee replacement.
Overall, we strongly advise against administering a cortisone injection after a knee replacement.
Can You Carry Out a Cortisone Injection Around a Joint Replacement?
Yes. Sometimes, pain after a knee replacement can be due to the prosthesis pinching soft tissue outside the joint. Examples include fat pad impingement, iliotibial band inflammation or nerve trapping. Sometimes, we use a targeted cortisone injection to reduce soft tissue inflammation. The cortisone injection should be performed with ultrasound guidance to enhance accuracy and prevent accidental injection into the joint.
If you experience pain after a knee replacement, consult your surgeon to rule out other potential causes, such as prosthesis loosening or malpositioning, infection, fractures, or a metal allergy.
What Are Other Options for Pain After a Knee Replacement?
Generally, physical therapy to improve knee strength and mobility will settle most cases of soft tissue pinching. Other options include medications for chronic pain, such as amitriptyline or duloxetine.
Other Commonly Asked Questions about Steroid Injections After a Knee Replacement
Does a cortisone shot before a knee replacement increase the risk of infection?
Yes. A recent systematic review of total knee replacements examined over 300,000 patients undergoing knee replacement. In this group, nearly half had a cortisone injection before their knee replacement. The alarming results suggest that a cortisone injection before a total knee replacement increases the risk of infection after surgery. This risk is high if the injeciton is performed within six weeks of surgery. And the risk of infection remains higher when cortisone injections are done within three months of surgery.
Can you perform a cortisone injection around a hip replacement?
Yes. However, just as with a knee replacement, we should avoid injecting into a hip replacement. However, in some cases, persistent hip pain can be due to the pinching of the hip flexor tendon against the hip prosthesis cup. Therefore, a targeted cortisone injection around the hip flexor tendon may help reduce hip pain.
Final Word from Sportdoctorlondon About Steroid Injection after Knee Replacement
A cortisone injection after a knee replacement is a high-risk procedure and should be avoided. If you have pain after a knee replacement, you should see your surgeon to exclude a severe cause for pain, such as infection, prosthetic loosening, or replacement malpositioning.
4 weeks after knee replacement
.Can I have a cortisone injection in my shoulder?
yes cortisone injection is allowed as long as you don’t have it in the knee joint.
LM
I recently (9/9/25) had a second full knee replacement, I had a great team on my recovery from day 1. From procedure to physical therepy. My results on range and pain levels were very good about week 9 everything went wrong from reduced range to moderate pain. Made it difficult getting around and very difficult getting sleep. I received a low dose cortisone from my surgeon and it increased my pain temporarily 3hrs max to reducing my pain at least by 60% with in 6hrs. By morning my pain was maybe a level 2 and I was able to get a better sleep on the first night. Doctor ordered an inflammation for 6 days. I go back in 6 weeks for follow up. To me just in the short time it has been 100% improvement on my continuing recovery.