Introduction: Intra-articular steroid injection has long been used to treat osteoarthritis of the knee and hip by orthopaedic surgeons, rheumatologists and general practitioners. Recent literature has shown conflicting results with regard to its safety. We aimed to investigate whether a relationship exists between preoperative intra-articular steroid injection and postoperative infection in total knee arthroplasty (TKA).

Patients and Methods: We reviewed the records of all patients having TKA between April 2005 and April 2007 in University Hospital Aintree, Liverpool. The operations were carried out by 6 consultants. Exclusion criteria for analysis were: previous knee infection, revision knee surgery, fracture around the knee, skin disorders, diabetes, blood transfusion, rheumatoid arthritis and immunosuppressive medication. Eligible patients were divided into two groups: group I had received intra-articular steroid injection (each subject receiving 1–3 (mean 1.6) injections between 1–12 (mean 5) months before TKA); group II had received no injection. Mean follow-up was 17 months.

Results: 425 patients had TKA, of which 361 met our criteria. 121 patients in group I and 240 patients in group II. No-one in group I developed acute infection. In group II, 7 patients developed acute infection (5 superficial and 2 deep) between 1 and 6 weeks (mean 3.7 weeks) post-operatively. There were no late infections. The difference in infection rate between groups I and II was not statistically significant (P=0.1, Fisher’s exact test).

Conclusion: We found no evidence that intra-articular steroid injection prior to TKA increased the incidence of postoperative infection.