Joint replacement is a standard operation for arthritis — the knee most commonly, then the hip and shoulder. These operations are usually reserved for severe arthritis that hasn’t responded to conservative treatment, including cortisone, hyaluronic acid, and PRP injections. Recent evidence suggests some injections may raise the infection risk if given too close to surgery. So how long should you wait for surgery after a cortisone shot?
Cortisone for arthritis
We use cortisone injections to reduce the pain and swelling of arthritis. Cortisone mimics cortisol, the hormone your adrenal glands make naturally. It’s a powerful anti-inflammatory — but it also strongly suppresses the immune system, which is the crux of the concern before surgery.
Why does cortisone increase the risk of infection?
We’re not entirely sure, but there are two likely reasons.
First, cortisone suppresses the immune system, reducing the body’s ability to fight infection. If cortisone is still present in the joint at the time of surgery, the risk of infection may be higher. Second, cortisone impairs wound healing, which can slow recovery after surgery and further raise the risk.
The evidence on infection risk after a cortisone shot
Many studies link cortisone injections to an increased risk of infection after knee or hip replacement. Most are observational, which makes them more prone to error — but the more robust systematic reviews point the same way.
A systematic review of over 300,000 knee replacements — nearly half of whom had a cortisone injection beforehand — found that a cortisone injection before a knee replacement increases the risk of infection afterwards. The risk is highest within six weeks of surgery, and remains raised within three months.
Similar findings apply to the hip: there’s a higher risk of infection if cortisone is given within 3 months of a hip replacement.
So how soon after a cortisone shot can you have surgery?
Based on this evidence, avoid a cortisone injection within three months of surgery. To be safe, many practitioners suggest waiting at least six months for surgery after a cortisone shot.
Frequently asked questions about waiting for surgery after a cortisone injection
How long should I wait for knee surgery after a cortisone injection?
We suggest waiting six months. The evidence shows the infection risk is elevated for at least three months, and possibly up to six months. To be on the safe side — and because the risk isn’t limited to knee replacement — waiting six months is the cautious approach. However, you should speak to your surgeon directly as he/she may have a different opinion. Some surgeons are not particularly worried about a cortisone injection before surgery, while others suggest waiting longer than 6 months.
Does a cortisone injection increase the risk of shoulder surgery?
It may. A study found that receiving a cortisone shot within 1 month of rotator cuff repair increases the risk of post-surgical infection. As with the knee and hip, leaving a gap between the injection and surgery is sensible.
Does a cortisone shot increase the risk of hand surgery?
Possibly. Some studies show an increased risk of infection if a cortisone injection is given within three months of hand surgery.
Do PRP or hyaluronic acid injections raise the infection risk before surgery?
We don’t think so — there’s no evidence that hyaluronic acid (viscosupplementation) or PRP before surgery increases the risk of postoperative infection. Even so, some surgeons suggest waiting six months after these injections too, to play it safe. Check with your surgeon.
Can I have a cortisone shot after my joint replacement?
That’s a separate question with its own risks. Injecting cortisone into a replaced joint is a high-risk procedure and generally avoided — see our guide to cortisone injections after a knee replacement.
What are my options for arthritis pain while I wait for surgery?
Plenty. Strengthening exercises, splints, taping, and orthotics all help arthritis pain. Topical treatments such as ibuprofen gel and capsaicin cream are useful, and oral ibuprofen or other NSAIDs reduce arthritis pain (mind the side effects). Other options include duloxetine.
Final word from Sport Doctor London about cortisone and surgery timing
The evidence suggests that a cortisone injection near a hip or knee replacement increases the risk of postoperative infection. It’s best to avoid a cortisone shot within six months of planned surgery. Hyaluronic acid and PRP appear less risky, but always check with your surgeon before proceeding.
If you’d like advice on managing arthritis pain while you wait for surgery, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
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