Timing of Steroid Injections Before Rotator Cuff Surgery Affects the Infection Risk
For patients undergoing arthroscopic rotator cuff repair, previous steroid injections into the shoulder don’t increase the risk of surgical site infection – unless the injection is administered within the month before surgery, according to a study published in The Journal of Bone & Joint Surgery.
Researchers from Rush University Medical Center used PearlDiver insurance database to identify more than 60,000 patients who had arthroscopic surgery for repair of a torn rotator cuff between 2007 to 2016 – 12,060 who had received a steroid injection in the year before surgery and 48,763 who had not received a shoulder injection during that time period. The overall infection rate was nearly identical between groups: 0.7% for patients who had received a shoulder injection in the year before surgery and 0.8% in those who did not.
However, among patients who had a steroid injection 1 month or less before surgery, the infection rate was significantly higher than that in the control group at 1.3%. Injections received at any other interval during the year before rotator cuff repair – from 2 to 12 months – did not affect the postoperative infection risk.
After adjusting for other factors, the researchers found that a steroid injection in the month before surgery was the single strongest predictor of postoperative infection. Other risk factors identified were consistent with findings from previous studies: male sex, smoking, obesity, and diabetes.
Symptomatic rotator cuff tears are common, occurring in more than 30% of the population, and steroid injections are often used to reduce pain and inflammation as part of conservative treatment. If surgery is indicated, surgeons may delay rotator cuff repair in patients who have received these injections due to concern over the risk of infection. However, until now there was little evidence on the risks of infection after a preoperative injection.
The new findings suggest that infection risk is increased only for patients who have a steroid injection within a month before rotator cuff surgery. Thereafter, the timing of shoulder injections seems to have no effect on the risk of infection.
That’s an important piece of information for orthopaedic surgeons, as many patients opt for – and insurers may require – a period of conservative treatment before surgery for rotator cuff tears.
Forsythe B, Agarwalla A, Puzzitiello RN, Sumner S, Romeo AA, Mascarenhas R. The Timing of Injections Prior to Arthroscopic Rotator Cuff Repair Impacts the Risk of Surgical Site Infection. J Bone Joint Surg. 2019 Apr 17;101(8):682-687. doi: 10.2106/JBJS.18.00631.