The Hip: Preservation, Replacement and Revision

Articular Steroid Injections


- Discussion: 
     - Steroid Menu:
     - Relative Potency of Various Steroids:
     - Triamcinolone: is the most common choice for joint injection (see knee osteoarthritis)

     - Cautions for Intra-Articular Injection:

          - local complications:
                 - may cause fat necrosis and loss of skin pigmentation in blacks;
                 - in some cases may accelerate joint degeneration;
          - system absorption may occur from intra-articular injection;
                 - absorption is increased by usage of water soluble preparations, dose injected, and injection into multiple joints;
                 - may cause transient hyperglycemia in diabetic patients (and therefore is contraindicated in type I or brittle diabetics);
                 - avascular necrosis of the femoral head is a rare complication;
          - iatrogenic septic arthritis: (see septic arthritis)
                 - uncommon problem but it does occur;
                 - all joint injections should be performed using sterile technique, with a formal betadine prep and use of sterile gloves or use of "no touch technique";
                 - association between total knee infection and prior steroid injections;
                        - Infection in knee replacements after previous injection of intra-articular steroid.
                        - Effect of intra-articular steroids on deep infections following total knee arthroplasty.
                        - Does intraarticular steroid infiltration increase the rate of infection in subsequent total knee replacements?

         - other
                 - note that intra-articular steroids may interfere w/ lactation in nursing mothers; (see pregnancy considerations)



Intraarticular corticosteroids in treatment of osteoarthritis.

Intra-articular corticosteroid treatment in osteoarthritis.

Injections in the treatment of osteoarthritis.

Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids.

Effect of intra-articular corticosteroids on ligament properties: a biomechanical and histological study in rhesus knees.

Intrasynovial injection of steroids uses and abuses.

Effects of local injection of corticosteroids on the healing of ligaments. A follow-up report.

Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial.

Variation patterns of two degradation enzyme systems in articular cartilage in different stages of osteoarthritis: regulation by dehydroepiandrosterone.

In Vitro Cytotoxic Effects of Benzalkonium Chloride in Corticosteroid Injection Suspension

A randomized, prospective, double-blind study to investigate the effectiveness of adding DepoMedrol to a local anesthetic injection in postmeniscectomy patients with osteoarthritis of the knee

Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and convalescence after arthroscopic meniscectomy

Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

Intraarticular triamcinolone acetonide for pain control after arthroscopic knee surgery

Skin Sterility After Application of Ethyl Chloride Spray



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, February 8, 2012 7:43 pm