Document Type : CURRENT CONCEPTS REVIEW
Department of Orthopedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, USA
Orthopedic surgeons commonly perform corticosteroid injections. These injections have systemic side
effects, including suppression of the hypothalamic-pituitary adrenal axis. Due to this suppression, there
is a theoretical risk of corticosteroid injections affecting the efficacy of the novel COVID-19 vaccines.
This potential interaction led the American Academy of Orthopedic Surgeons to recommend, “avoiding
musculoskeletal corticosteroid injections for two weeks before and one week after COVID vaccine
administration.” This review examines the literature underlying this recommendation. An extensive
literature review was performed through PubMed, MEDLINE, and Google Scholar from database
inception to May 2022. Keywords searched were COVID, coronavirus, vaccine, vaccination, steroids,
and corticosteroids. Search results included articles written in the English language and encompassed
reviews, case series, empirical studies, and basic science articles. There is no definitive evidence that
corticosteroid injections affect COVID-19 vaccine efficacy or increase the risk of contracting COVID.
The authors recommend orthopedic surgeons follow the AAOS guidelines, which recommend avoiding
injections two weeks before and one week following COVID vaccine administration. Additional research
is needed to better define this theoretical risk, especially since there is good evidence that injections
suppress the hypothalamic-pituitary-adrenal-axis.
Level of evidence: IV