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Before having a hip replacement for my left leg two years ago, I had a series of steroid injections that really helped. In fact, I think those injections made it possible to put off having the surgery for a good year or more. Now that I'm starting to have the same problems on the right side, my doctor is balking at doing the injections. Something about the risk of joint infection. I really want the injections. How do I convince him otherwise?

It might help you to understand potentially where the physician is coming from on this issue. Research has shown that there may be a link between steroid injections before hip replacement and serious hip joint infection after the procedure. One study reported a 30 per cent rate of hip infection after hip replacement when a steroid injection was given before the procedure. Since that time, there has been increased attention on the part of orthopedic surgeons when considering steroid injection into the hip. The concern for joint infection after replacement is very real. Experts recommended using caution and good clinical judgment when using steroid injections to relieve hip pain for osteoarthritis. And surgeons were advised to avoid using this technique within a two-month period of time before hip replacement. But the subject is controversial as a recent study showed. In this study from Newfoundland, surgeonstook a look back over the records of 96 patients evaluating whether or not a steroid injection into the hip was linked with infection after hip replacement. They conducted the study because of the previous reports that this may be the case. And since steroid injections are often used to diagnose the problem and then used as an alternative to surgery, this information is important. Anyone who has suffered enough hip pain to end up with a hip replacement doesn't need the extra aggravation of a joint infection that requires another surgery. In this study, there were two groups of patients evenly matched by age, sex (male or female), diagnosis, and year of surgery. All of the patients had a hip replacement (referred to in medical terms as a total hip arthroplasty or THA). One group had steroid injections two to six months before the replacement surgery. The second (control) group did not have any steroid injections into the hip. There was no difference between the two groups in regards to hip joint infection after the hip replacement. In fact, there were no differences in relation to any complications (e.g., dislocation, fractures, need for revision surgery). Based on these results, the question was discussed -- steroid injection before hip replacement: yes or no? The authors made several suggestions. First, a reminder that there are many potential reasons why a patient may develop joint infection after hip replacement. Nutrition, comorbidities (presence of other illnesses or diseases), and type of body (size, shape) are just a few considerations. Second, their study was fairly small so different results might be found with a larger sample size. Only 15 of the 96 patients had an injection two months before the surgery. Again, this may be too small of a sample set to show significance. And only one surgeon performed all of the injections using the same technique(s) with each patient. Special care was given to keep everything sterile in order to reduce the risk of infection. Any of these (or a combination of these) factors could have contributed to the positive results. The authors concluded that previous reports of infection after hip replacement linked with preoperative steroid injections must be taken seriously. Steroid injections into the hip before total hip replacement are not contraindicated. But until researchers are able to clearly identify cause and effect, and risk and benefit of this treatment, it is best to continue following current precautions. With this knowledge of the overall situation, you may want to talk with your physician about his hesitations in your case. Use the next visit to weigh pros and cons of steroid injection use and discuss all your options. A win-win situation is possible when both you and your physician agree as to the best treatment approach for you based on all factors.

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