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Introduction <p>Septic arthritis is a rare but devastating complication of intra-articular corticosteroid injection (CSI), associated with significant medical morbidity and poor clinical outcomes. Although previous studies have examined risks associated with CSI, few have tracked patients long-term. This study evaluates the incidence, timing, and patient characteristics related to iatrogenic septic arthritis within 6 months of receiving a large joint CSI, offering new insights to inform clinical practice.</p> Materials and methods <p>A retrospective, descriptive cohort study was conducted using SlicerDicer, a software stratification system within Epic, to identify patients diagnosed with septic arthritis within six months of receiving an intra-articular CSI of the hip, knee, or shoulder. Data were collected from a single institution over a 10-year period (July 1, 2010 to July 1, 2020). Individual chart review was used to obtain patient demographics, clinical characteristics, and procedural details for identified cases.</p> Results <p>Of 15,021 intra-articular corticosteroid injections performed, 14 cases of septic arthritis were identified within 6 months of the procedure, resulting in an incidence rate of 0.093%. Of the affected patients, 21% had underlying inflammatory arthritis, and 21% had underlying comorbidities resulting in immunosuppression. The median time to diagnosis was 3.5 (range 1–16) weeks post-injection, with a bimodal distribution of infections occurring primarily between 1 and 3 and 7–10 weeks post-injection. <i>Staphylococcus aureus</i> (42%) and coagulase-negative <i>Staphylococcus</i> species (36%) were the most commonly isolated organisms.</p> Conclusions <p>Large joint intra-articular CSI presents a low risk (&lt; 0.1%) for developing septic arthritis, but can present up to 16 weeks post-injection. The preliminary observation of bimodal timing and delayed presentation of septic arthritis suggests that a standard two-week surveillance window may not be long enough to fully capture all infections, particularly those involving lower-virulence organisms. These findings highlight the need for informed risk stratification and prolonged vigilance well beyond the immediate post-injection period to identify infectious complications after large joint CSI.</p>

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Septic arthritis following intra-articular corticosteroid injections: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月9日

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  • Marlena Rose Mueller,
  • Travis Cleland,
  • Corrilynn O. Hileman,
  • Andrew Olsen,
  • Robert Wissner,
  • Kimberley R. Monden

摘要

Introduction

Septic arthritis is a rare but devastating complication of intra-articular corticosteroid injection (CSI), associated with significant medical morbidity and poor clinical outcomes. Although previous studies have examined risks associated with CSI, few have tracked patients long-term. This study evaluates the incidence, timing, and patient characteristics related to iatrogenic septic arthritis within 6 months of receiving a large joint CSI, offering new insights to inform clinical practice.

Materials and methods

A retrospective, descriptive cohort study was conducted using SlicerDicer, a software stratification system within Epic, to identify patients diagnosed with septic arthritis within six months of receiving an intra-articular CSI of the hip, knee, or shoulder. Data were collected from a single institution over a 10-year period (July 1, 2010 to July 1, 2020). Individual chart review was used to obtain patient demographics, clinical characteristics, and procedural details for identified cases.

Results

Of 15,021 intra-articular corticosteroid injections performed, 14 cases of septic arthritis were identified within 6 months of the procedure, resulting in an incidence rate of 0.093%. Of the affected patients, 21% had underlying inflammatory arthritis, and 21% had underlying comorbidities resulting in immunosuppression. The median time to diagnosis was 3.5 (range 1–16) weeks post-injection, with a bimodal distribution of infections occurring primarily between 1 and 3 and 7–10 weeks post-injection. Staphylococcus aureus (42%) and coagulase-negative Staphylococcus species (36%) were the most commonly isolated organisms.

Conclusions

Large joint intra-articular CSI presents a low risk (< 0.1%) for developing septic arthritis, but can present up to 16 weeks post-injection. The preliminary observation of bimodal timing and delayed presentation of septic arthritis suggests that a standard two-week surveillance window may not be long enough to fully capture all infections, particularly those involving lower-virulence organisms. These findings highlight the need for informed risk stratification and prolonged vigilance well beyond the immediate post-injection period to identify infectious complications after large joint CSI.