Cortisone Injections Before Hip or Knee Replacement: How Long Should You Wait?

If you're considering a hip or knee replacement, you've probably wondered whether a cortisone injection is still an option for pain relief. One of the most common questions I hear is: “Can I get one more cortisone shot before surgery?”

The answer is sometimes — but timing matters. Research suggests that an injection given too close to a joint replacement may increase the risk of infection after surgery. The overall risk remains low, but infection after a hip or knee replacement is one of the most serious complications we work to prevent. Because of this, I generally recommend waiting at least three months between a cortisone injection and a hip or knee replacement.

Why are we concerned about cortisone?

Cortisone (corticosteroid) injections reduce inflammation and temporarily relieve arthritis pain. Many patients get less pain, better mobility, a better ability to exercise, and relief lasting weeks to months — they're an excellent treatment for people postponing surgery.

But cortisone also temporarily affects the body's immune response. Even though the medication goes into the joint rather than the whole body, researchers believe it may create a short window during which bacteria have a better chance of establishing an infection if surgery is performed too soon afterward.

Does it really increase infection risk?

The evidence suggests yes — primarily when surgery is performed within about three months of the injection. Multiple large studies and meta-analyses have found:

For this reason, many orthopedic surgeons — including me — use a three-month waiting period as a safety guideline.

Does it matter which joint was injected?

Yes. The concern is specifically an injection into the same joint that will be replaced:

Why is infection such a big deal?

Fortunately, infection after joint replacement is uncommon. But when it occurs, treatment can involve additional surgery, removal of the implant, IV antibiotics, months of recovery — and occasionally multiple operations before a new joint can be implanted. Because these infections are so hard to treat, even a small avoidable increase in risk is something we take seriously. (More in hip and knee replacement complications.)

What if my pain is severe?

This is the hardest situation, and it usually comes down to two honest options:

Option 1: Proceed with surgery

If you're already ready for a joint replacement, moving forward may be the most definitive solution — rather than another temporary injection that pushes your surgery date back.

Option 2: Have another injection

If you're not yet ready — or need to delay surgery for work, travel, or personal reasons — another cortisone injection may still be entirely appropriate. Just go in knowing that the injection typically means waiting at least three months before your replacement.

What about hyaluronic acid (gel) injections?

Patients often ask whether gel injections are different. Some studies have also suggested a possible increase in infection risk when hyaluronic acid is given shortly before joint replacement, though the evidence is less consistent than for cortisone. Because of that, many surgeons apply the same three-month precaution to gel injections before surgery.

My approach

Cortisone injections remain an excellent treatment for many patients with arthritis — part of the full toolkit of nonsurgical care that can meaningfully delay surgery. But if a replacement is coming into view, plan the sequence deliberately.

In my practice, I generally recommend at least three months between a cortisone injection into the joint being replaced and surgery — based on the best available evidence, to minimize the risk of the one complication we most want to avoid.

Schedule a consultation with Dr. Harb to talk through the timing that's safest for your situation — and see how to prepare for joint replacement when the time comes.