The risk of
sepsis with a hip or knee implant does not seem to be increased by prior joint
injections, as long as the injection and surgery are separated by at least two months. Calcifications have been reported after intradiscal injection in the coccygeal region for coccydynia. Complete rest for 24 hours after injection of
triamcinolone hexacetonide into the knee had no effect on systemic diffusion of the product. Patients infected by HIV who are treated with
ritonavir are at much greater risk for
Cushing syndrome after
epidural injection. Problems with menstruation after
corticosteroid injection seem to be related to a transient decrease in
estradiol levels, without alterations in FSH and LH levels. The risk of
central serous chorioretinopathy and acute
necrosis of the retina after injection is not known, even by ophthalmologists. Transient
dysphonia occurs in 12% of patients receiving
corticosteroid injections. The impressive Tachon's syndrome seems to be the venous counterpart to
Nicolau's syndrome for arteries.
Injections into C1-C2 should be abandoned because of the neurological risks. Since serious neurological events after foraminal
injections could be the result of an overly fast injection into the arterialized radicular veins rather than in the arteries, only slow
injections with products having a low risk of
embolism or vascular complications should be allowed.
Dexamethasone-based preparations seem to contain no particles or crystals, and have not induced any neurological accidents in various animal models, even after direct administration into vertebral or carotid arteries.