Is there a risk of a deep infection after intra-articular injections prior to a total knee replacement?

The aim of the study is to identify the risks associated with an intra-articular injection prior to a total knee arthroplasty (TKA). 1628 patients were retrospectively studied over a seven-year time period. The patients were divided into two groups; patient who received an intra-articular injection prior to a TKA and patients who did not receive an injection prior to a TKA. There were 16 deep infections identified (0.98%). 10 deep infections were identified in the patients who did not receive an injection prior to a TKA (1.18%) and 6 deep infections were identified in patients who received an injection prior to a TKA (0.77%). There does not appear to be a correlation with the timing of the injection prior to surgery and increased risk of infection.



Literature:
Amin NH et al. The Risk of a Deep Infection Associated With Intra-Articular Injections Prior to a Total Knee Arthroplasty. J Arthroplasty 2015, online 19. August; doi: 10.1016/j.arth.2015.08.001

Risk factors of OA after ACL injuries

Anterior cruciate ligament (ACL) rupture is a common sports-related injury, with an annual incidence of approximately 5/10 000 persons in the general population.^[1] Osteoarthritis (OA) is a well-known, long-term complication of ACL rupture, with a prevalence of 10–90% at 10–20 years postinjury.^[2,3] It is important to identify the risk factors contributing to OA in patients with ACL rupture, because some risk factors may be modifiable as to prevent onset or early-stage progression of OA.

To identify those ACL injured patients at increased risk for knee OA, it is necessary to understand risk factors for OA.

Aim To summarise the evidence for determinants of (1) tibiofemoral OA and (2) patellofemoral OA in ACL injured patients.

Methods MEDLINE, EMBASE, Web of Science and CINAHL databases were searched up to 20 December 2013. Additionally, reference lists of eligible studies were manually and independently screened by two reviewers. 2348 studies were assessed for the following main inclusion criteria: ≥20 patients; ACL injured patients treated operatively or non-operatively; reporting OA as outcome; description of relationship between OA outcome and determinants; and a follow-up period ≥2 years. Two reviewers extracted the data, assessed the risk of bias and performed a best-evidence synthesis.

Results Sixty-four publications were included and assessed for quality. Two studies were classified as low risk of bias. Medial meniscal injury/meniscectomy showed moderate evidence for influencing OA development (tibiofemoral OA and compartment unspecified). Lateral meniscal injury/meniscectomy showed moderate evidence for no relationship (compartment unspecified), as did time between injury and reconstruction (tibiofemoral and patellofemoral OA).

Conclusions Medial meniscal injury/meniscectomy after ACL rupture increased the risk of OA development. In contrast, it seems that lateral meniscal injury/meniscectomy has no relationship with OA development. Our results suggest that time between injury and reconstruction does not influence patellofemoral and tibiofemoral OA development. Many determinants showed conflicting and limited evidence and no determinant showed strong evidence.

Read more:

Belle L van Meer; Duncan E Meuffels; Wilbert A van Eijsden; Jan A N Verhaar; Sita M A Bierma-Zeinstra; Max Reijman: Which Determinants Predict Tibiofemoral and Patellofemoral Osteoarthritis After Anterior Cruciate Ligament Injury? -A Systematic Review. Br J Sports Med. 2015;49(15):975-983

The Clinical Course Over the First Year of Whiplash Associated Disorders (WAD)

This study was found helpful to distinguish between the good and poor healing patients after "whiplash injuries".

Background 

Different recovery patterns are reported for those befallen a whip-lash injury, but little is known about the variability within subgroups. The aims were (1) to compare a self-selected mildly affected sample (MILD) with a self-selected moderately to severely affected sample (MOD/SEV) with regard to background characteristics and pain-related disability, pain intensity, functional self-efficacy, fear of movement/(re)injury, pain catastrophising, post-traumatic stress symptoms in the acute stage (at baseline), (2) to study the development over the first year after the accident for the above listed clinical variables in the MILD sample, and (3) to study the validity of a prediction model including baseline levels of clinical variables on pain-related disability one year after baseline assessments.

Methods 

The study had a prospective and correlative design. Ninety-eight participants were  consecutively selected. Inclusion criteria; age 18 to 65 years, WAD grade I-II, Swedish language skills, and subj ective report of not being in need of treatment due to mild symptoms. A multivariate linear regression model was applied for the prediction analysis.

Results 

The MILD sample was less affected in all study variables compared to the MOD/SEV sample. Pain-related disability, pain catastrophising, and post-traumatic stress symptoms decreased over the first year after the accident, whereas functional self-efficacy and fear of movement/(re)injury increased. Pain intensity was stable. Pain-related disability at baseline emerged as the only statistically significant predictor of pain-related disability one year after the accident (Adj r2 = 0.67).

Conclusion 

A good prognosis over the first year is expected for the majority of individuals with WAD grade I or II who decline treatment due to mild symptoms. The prediction model was not valid in the MILD sample except for the contribution of pain-related disability. An implication is that early observations of individuals with elevated levels of pain-related disability are warranted, although they may decline treatment.

Read more:

Pernilla Åsenlöf; Annika Bring; Anne SöderlundThe Clinical Course Over the First Year of Whiplash Associated Disorders (WAD). BMC Musculoskelet Disord. 2013;14(361)