Corticosteroid joint
injections are perceived as being an effective treatment for symptomatic
knee osteoarthritis, with a very low risk of complications. While the procedure is often performed in secondary care by orthopaedic surgeons and rheumatologists (and trainees in either specialty), the role of general practitioners (GPs) in
chronic disease management has long existed with joint
injections also frequently performed in primary care. The perception that serious complications from
corticosteroid knee joint
injections are rare and that their benefits in treating symptomatic
knee osteoarthritis significantly outweigh the risks has not been well addressed. We present a case of a 71-year-old obese female who presented to her general practitioner (GP) with worsening left knee
pain and radiographic changes consistent with
osteoarthritis. She was administered a
corticosteroid joint injection, which gave minimal relief, and over the next few days resulted in worsening severe
pain,
erythema and swelling. She returned to the GP who commenced oral
antibiotics and referred her to casualty. A large knee
abscess was diagnosed and intravenous
antibiotics were commenced. The patient was admitted under the orthopaedic surgeons with her treatment consisting of multiple
surgical procedures over a prolonged duration. Although lengthy, her postoperative recovery was unremarkable. Based on this case report and our review of the literature, we highlight the potential complications associated with
corticosteroid knee joint
injections and suggest certain patients for whom we would recommend secondary referral before any intervention in primary care.