The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

The Effect of Intra-articular Corticosteroid Injections on Vaccine Efficacy: A Current Concepts Review

Document Type : CURRENT CONCEPTS REVIEW

Authors
R . Timothy Kreulen
Adam Margalit
Andrew S. Miller
Uma Srikumaran
John H. Wilckens
Dawn LaPorte
Department of Orthopedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, USA
10.22038/abjs.2023.68418.3263
Abstract
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
Keywords
Corticosteroid
COVID
Injection
Vaccine
Subjects
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The Archives of Bone and Joint Surgery
Volume 11, Issue 5
May 2023
Pages 306-312

  • Receive Date 02 December 2022
  • Revise Date 01 May 2023
  • Accept Date 22 January 2023