Risk analysis of periprosthetic knee joint infection (PJI) in total knee arthroplasty after preoperative corticosteroid injection: a systematic review : A study performed by the Early-Osteoarthritis group of ESSKA-European Knee Associates section.

PURPOSE: Intra-articular corticosteroid injection is widely used for symptomatic relief of knee osteoarthritis. However, if pain is not improved which consequences a total knee arthroplasty (TKA), there is a potential risk of post-operative periprosthetic joint infection (PJI). The aim of this study is to investigate whether the use of preoperative intra-articular corticosteroid injection increases the risk of PJI and to investigate a time frame in which the risk of subsequent infection is significantly increased. METHODS: A systematic search was performed in PubMed (Medline), Scopus, and the Cochrane Library. Inclusion criteria were original studies investigating the rate of PJI in patients receiving pre-operative intra-articular corticosteroid injection compared to controls. RESULTS: A total of 380 unique articles were screened. Six studies met the inclusion criteria with 255,627 patients in total. Overall, no statistical significance was observed in the intra-articular infection rate in corticosteroid compared to controls groups. However, intra-articular corticosteroid injections within 3 months prior to TKA were associated with a significantly increased risk of infection (OR: 1.52, 95% CI 1.37-1.67, p < 0.01); this was not observed in the 6 month period (OR: 1.05, 95% CI 0.80-1.39, p = 0.72). CONCLUSIONS: Performing an intra-articular corticosteroid injection within 3 months prior to TKA is associated with a significantly increased risk of PJI. The current evidence supports the safe use of intra-articular corticosteroid injection more than 6 months before TKA. However, additional studies are needed to clarify the risk of PJI after TKA implantation between 3 and 6 months after the last corticoid injection. LEVEL OF EVIDENCE: IV.

Does the sternum play a role in the aetiopathogenesis of adolescent idiopathic scoliosis? Preliminary data of a new theory.

BACKGROUND: The role of the sternum, if any, in the aetiopathogenesis of adolescent idiopathic scoliosis (AIS) remains unexplored. We evaluated morphological features of the sternum for the first time in individuals with AIS. METHODS: Medical records of a tertiary hospital were reviewed from 2010 to 2018 to identify adolescents with thoracic or thoracolumbar AIS. We included scoliotic patients between 14 and 18 years of age on radiologic evaluation without previous treatment for the disease. A complete history and 3D computed tomography (CT) scan were also prerequisites for study inclusion. We compared the shape and position of the sternum between adolescents with AIS and age-matched individuals as control. The control group was recruited with a random selection from patients attending hospital for extraskeletal reasons during the same period. Using CT, we evaluated the part of the sternum found in the right front quadrant of the axial plane at the level of the middle of the manubrium of the sternum and apical vertebra.  We also provided an evidence-based theory of the sternum involvement in AIS aetiopathogenesis. RESULTS: Twelve scoliotic patients with mean age 16.6 and mean Cobb angle 39.7 degrees were included in the study. No difference was found between groups at the level of the manubrium of the sternum (p =0.486). At the level of the apical vertebra, there was a significant difference of the part of sternum found in the right front quadrant of the axial plane between groups (95 % vs 56 %, p <0.001). CONCLUSIONS: These are preliminary data demonstrating for the first-time morphological differences of the sternum, between AIS and age-matched non-scoliotic individuals. The sternum of adolescents with AIS was more inclined than non-scoliotic controls that could raise the hypothesis of sternum involvement in AIS pathogenesis. HIPPOKRATIA 2018, 22(4): 173-177.

Transtendinous course of the infrapatellar branch of saphenous nerve. A contribution to the aetiology of entrapment neuropathy and modification of the existing classification.

BACKGROUND: The course of the infrapatellar branch of saphenous nerve (IPBSN) in relation to the Sartorius muscle has been classified into presartorial, transsartorial and retrosartorial types. Mechanical compression of the IPBSN within the Sartorius tendon has been surgically recognised as a cause of entrapment neuropathy. Purpose of the present study was to differentiate the IPBSNs penetrating the Sartorius tendon from those penetrating the Sartorius muscle, from an anatomical and clinical point of views and thus modifying the existing classification. MATERIALS AND METHODS: The IPBSN was bilaterally dissected in 27 cadavers. The cases of the IPBSNs penetrating the Sartorius tendon were recorded separately from those penetrating the Sartorius muscle belly. RESULTS: In 11 out of 54 limbs (20.4%) the IPBSN ran through the Sartorius muscle belly. In 3 out of 54 (5.6%) limbs, the IPBSN penetrated the Sartorius tendon. CONCLUSIONS: The penetrating type of IPBSN includes two distinct subtypes: the muscle-penetrating type and the tendon-penetrating type. These subtypes are also distinct from a clinical point of view, since only the tendon-penetrating type has been associated with the IPBSN entrapment neuropathy. According to these findings we suggest a modification of the current classification. Further clinical studies are necessary to fully demonstrate whether the tendon-penetrating type should be considered as a predisposing factor for the IPBSN entrapment neuropathy. Distinguishing the two subtypes might be helpful for that purpose.