Preoperative corticosteroid injections are associated with a higher periprosthetic infection rate following primary total shoulder arthroplasty: a systematic review and meta-analysis.

BACKGROUND: Corticosteroid injections (CSIs) are commonly used for the treatment of shoulder pain in patients with osteoarthritis and rotator cuff arthropathy. These injections may increase the risk of infection following eventual shoulder arthroplasty. The purpose of this study was to perform a systematic review and meta-analysis of existing data to explore the relationship between preoperative CSI's and postoperative periprosthetic joint infection (PJI) following shoulder arthroplasty. METHODS: A literature search was performed on PubMed, Embase, and Web of Science databases through September 29, 2023. Of the 4221 retrieved, 7 studies including 136,233 patients were included for qualitative analysis. Studies describing patients receiving CSI prior to shoulder arthroplasty and the effect on postoperative infection risk were included in the systematic review and subsequent meta-analysis. Assessment of risk of bias was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS: Receiving a CSI prior to shoulder arthroplasty was found to have a statistically significant association with increased risk for PJI (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06-1.19; P < .0001). The rate of PJI increased when injections were given closer to the time of surgery. Patients who received an injection at any time point before surgery had a 5.4% risk of PJI compared to 7.9% and 9.0% in patients receiving an injection within 3 months and 1 month of surgery, respectively. This time dependent association however did not reach statistical significance: 1 month OR 1.48; 95% Cl: 0.86-2.53; P = .16, 3 months OR 1.95; 95% Cl: 0.95-4.00; P = .07. CONCLUSION: The results of this systematic review and meta-analysis demonstrate that patients receiving corticosteroid shoulder injections prior to shoulder arthroplasty may be at an increased risk for PJI postoperatively. While time dependent stratification did not reach statistical significance, our findings indicate a clear trend of increased risk for patients receiving injections closer to surgery.

Operating room disinfection: operator-driven ultraviolet 'C' vs. chemical treatment.

Background: In operating room (OR) surfaces, Nosocomial pathogens can persist on inanimate surfaces for long intervals and are highly resistant to traditional surface cleaning. Aim: This study compares traditional chemical operating room terminal disinfection to a unique operator-driven device that emits germicidal UV light at short distance onto vertical and horizontal surfaces. Methods: A randomized crossover analogous protocol assigned 40 end-of-day operating rooms into either group A (chemical then UVC treatments) or group B (UVC then chemical treatments). Initial Staphylococcal cultures were obtained prior to disinfection treatment, after the first treatment, and after the second treatment at 16 most commonly contaminated sites to represent overall room contamination. Success was defined as no growth and failure as 1 or more colony forming units. Thoroughness of chemical treatment vs UVC treatment was compared and used to determine if the second treatment was additive to the first treatment within each group. Findings: The operator driven UVC device outperformed chemical treatment in reducing the number of contaminated sites in the OR by more than half (P<0.001). Operator-driven UVC reduced contaminated sites after chemical treatment by nearly half (P<0.001). In contrast, chemical treatment after operator-driven UVC did not significantly reduce the number of contaminated sites. The mean employee time of disinfection for chemical treatment was 49 minutes and for the operator-driven UVC emitter 7.9 minutes (P<0.001). Conclusions: This study demonstrates that addition of an operator-driven UVC emitter to OR rooms between cases could be helpful in overall decreasing the number of contaminated sites.

Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy for Prescribing Recommendations and Community Safety.

BACKGROUND: Orthopaedic surgeons are confronted with a difficult dilemma: managing acute pain postoperatively and balancing the risk of prescription opioid use. To our knowledge, a prospective performance-improvement project providing opioid-prescription recommendations based on the actual amounts of usual and customary medication consumed following simple knee meniscectomy has not been described. METHODS: One hundred and two patients undergoing arthroscopic knee meniscectomy prospectively recorded postoperative pain medications in a pain journal. Arthroscopic procedures were performed at 2 centers by 9 fellowship-trained senior surgeons. Various usual and customary prescribing protocols were observed, and the amount of medication consumed was recorded. Prescription and over-the-counter pain medication, quantity, frequency, and visual analog scale (VAS) pain scores were collected. RESULTS: One hundred and two patients filled a prescription opioid medication and were included in the study. A total of 3,765 pills were prescribed, and a total of 573.5 were consumed. For the 102 patients who filled a prescription, the average time consuming opioid medication was 2 ± 2 days (range, 0 to 13 days) postoperatively. No cases of persistent use were recorded. Of the 102 patients who filled a prescription, 29.4% did not take any prescription opioids postoperatively. A total of 3,191.5 pills (or 22,183.75 morphine milligram equivalents [MME]) were unused and were potentially available to the community. CONCLUSIONS: Following simple knee arthroscopy, the amount of prescribed opioid medication exceeds the need for postoperative pain management. In general, 68% of patients require a maximum of 13 pills postoperatively for 6 days. Surgeons should adjust prescribing standards accordingly to limit the amount of prescription opioids available to the community. Furthermore, a comprehensive response to include increased patient screening and monitoring as well as opioid use and disposal education is recommended.

In vivo quantification of lumbar disc degeneration: assessment of ADC value using a degenerative scoring system based on Pfirrmann framework.

PURPOSE: To evaluate the role of apparent diffusion coefficient (ADC) as a quantitative means to assess the degree of intervertebral disc (IVD) degeneration contextually within the framework of a widely used Pfirrmann classification rather than in a direct correlation with Pfirrmann grades. METHODS: DWI and T2-weighted (T2w) of lumbar spine were acquired from nine healthy volunteers (age range 27-62 years, mean age 45 years) with a 3T MR scanner. ADC values were obtained from each of the five lumbar discs via a pixel-by-pixel ADC calculation as well as via region of interest-averaged image intensities. Disc degeneration was assessed by a scoring system via sequential application of Pfirrmann scale and use of intensity ratio of IVD/cerebrospinal fluid in T2w for discs in each Pfirrmann grade to be further separated. RESULTS: A significant correlation was observed between degenerative scores and ADC independent of how ADC was obtained (Spearman's ρ < -0.85, P < 2 × 10(-14)). CONCLUSIONS: This study demonstrates that previously perceived as an overlap in ADC value existing between different degenerative categories based on a visual inspection can be viewed as a quantitative role of ADC in assessment of disc degeneration. This reinforces the Pfirrmann classification system but also proceeds beyond mere qualitatively determining morphologic states.

Association between intervertebral disc degeneration and endplate perfusion studied by DCE-MRI.

PURPOSE: The goal of this study was to study the association between solute transport mechanisms in cartilaginous disc endplates and the degeneration of intervertebral discs. Intervertebral disc degeneration is a multi-factorial process. It is suspected that poor nutrient delivery to discs might be a factor leading to degeneration. Several studies suggest that defects in disc endplates could lead to poor transport of nutrients. An imaging technique assessing endplate perfusion could be a valuable tool in investigating disc degeneration. There is currently no universally accepted technique assessing endplate perfusion in vivo. METHODS: Nine adult patients exhibiting varying levels of intervertebral disc degeneration were included. MRI was used to study the association between blood perfusion in 90 lumbar disc endplates and disc degeneration in 45 lumbar discs. Solute transport mechanism through endplates was assessed indirectly by dynamic contrast enhanced (DCE) MRI. T2-weighted MRI was used for conventional Pfirrmann classification. RESULTS: A positive association was observed between Pfirrmann grades and endplate DCE-MRI enhancement. A differential enhancement between cranial and caudal endplates was also observed, which increased with Pfirrmann grades. This differential enhancement was also dependent on the lumbar level. CONCLUSIONS: Increased MRI signal enhancement in the cartilaginous endplates of degenerated discs might indicate damage to the subchondral bone of the vertebral bodies. The endplate enhancement characteristic could aid in understanding the pathophysiology of disc degeneration and planning treatment more effectively.