The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty

2020 ◽  
pp. 175857322092581
Author(s):  
Jourdan M Cancienne ◽  
Brian C Werner
Keyword(s):  
Shoulder Arthroplasty ◽  
Periprosthetic Infection ◽  
Corticosteroid Injection ◽  
Joint Infection ◽  
Early Infection ◽  
Control Group ◽  
Prosthetic Joint ◽  
Shoulder Arthroplasties ◽  
Procedure Type ◽  
Corticosteroid Injections

Background There is little literature examining the association of corticosteroid injections into shoulders with a pre-existing arthroplasty. The aim of the current study was to determine the risk of early infection following intra-articular corticosteroid injection into a pre-existing shoulder arthroplasty. Methods The PearlDiver database was retrospectively reviewed to identify patients with a pre-existing shoulder arthroplasty from 2007 to 2017. Patients with an ipsilateral shoulder corticosteroid injection in the postoperative period were identified. A control group of patients without an injection was matched 4:1 by age, gender, and postoperative timepoint. Periprosthetic infection within six months after the injection was then assessed and compared using a logistic regression analysis. Results Nine hundred and fifty-eight patients were identified who underwent a postoperative corticosteroid injection into a pre-existing shoulder arthroplasty and compared to 3832 control patients. After controlling for demographics, comorbidities, and procedure type, the rate of infection in patients who received a postoperative corticosteroid injection (1.77%) was significantly higher than control patients who did not receive an injection (0.91%) (OR 1.98 (95% CI 1.31–2.98), p = 0.0253). Conclusions There is a significant association between intra-articular shoulder corticosteroid injections in patients with pre-existing shoulder arthroplasties and prosthetic joint infection compared to matched controls without postoperative injections. Study Design Level III, retrospective cohort study.

Factors Associated With Elevated Inflammatory Markers Prior to Shoulder Arthroplasty

2021 ◽  
pp. 155633162199866
Author(s):  
Kyle J. Kopechek ◽  
Gregory L. Cvetanovich ◽  
Joshua S. Everhart ◽  
Travis L. Frantz ◽  
Richard Samade ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroplasty ◽  
Joint Infection ◽  
Reactive Protein ◽  
Acute Fracture ◽  
Prosthetic Joint ◽  
Academic Medical ◽  
Multiple Variable ◽  
Independent Risk Factors ◽  
Shoulder Arthroplasties

Background: Preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) ranges for several shoulder arthroplasty indications are not well understood. Purpose: We sought to compare preoperative ESR and CRP values for a variety of shoulder arthroplasty indications and evaluate risk factors for elevated preoperative ESR and CRP values. Methods: We conducted a retrospective cohort study of shoulder arthroplasty cases performed at a single academic medical institution from 2013 to 2018. Preoperative ESR and CRP values for 235 shoulder arthroplasties with various indications were recorded. Independent risk factors for elevated values (CRP > 10.0 mg/L and ESR > 30.0 mm/h) were determined via multiple variable logistic regression. Results: Patients undergoing shoulder arthroplasty for osteoarthritis had an ESR (mean ± SD) of 22.6 ± 17.8, with 29.8% of patients elevated, and a CRP of 6.5 ± 6.4, with 25.5% of patients elevated. Arthroplasty for acute fracture and prosthetic joint infection (PJI) had higher preoperative ESR and CRP values. Multivariate analysis identified several predictors of elevated ESR, including infection, acute fracture, diabetes, and female sex. It also identified predictors of elevated CRP, including infection, acute fracture, and younger age. Conclusions: Preoperative ESR and CRP values may be elevated in 25% to 30% of patients undergoing primary shoulder arthroplasty. Arthroplasty for both acute fracture and PJI, along with several other patient factors, was associated with elevated preoperative ESR and CRP. Thus, routine collection of ESR and CRP preoperatively may not be of benefit, as elevated values are common. Further study is warranted.

Short-term Changes After Corticosteroid Injections Into the Normal Tendons of Rabbits: A Controlled Randomized Study

2019 ◽  
Vol 47 (3) ◽  
pp. 721-728 ◽  
Author(s):  
Kandir Genesio Innocenti Dinhane ◽  
Alexandre Leme Godoy-Santos ◽  
Alexandre Todorovic Fabro ◽  
Maria Regina Moretto ◽  
Igor Deprá ◽  
...  
Keyword(s):  
Single Injection ◽  
Corticosteroid Injection ◽  
Healing Process ◽  
Test Group ◽  
Control Group ◽  
Placebo Control ◽  
Short Term ◽  
Calcaneal Tendon ◽  
The Right ◽  
Corticosteroid Injections

Background: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopaedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Purpose: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Study Design: Controlled laboratory study. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group—in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group—in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, animals were euthanized and tendons were harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load × elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group had a significant reduction in MMP2 expression as compared with the control groups ( P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased duration of follow-up, various doses, and multiple injections and in tendinopathic models. Clinical Relevance: Some previous studies demonstrated early structural changes in tendons after a single corticosteroid injection, which was not corroborated by the present study. Metalloproteinase decrease is usually associated with a reduction in collagen degradation, which would be protective for the healing process. More studies are necessary to confirm the possible beneficial effect of these results in the long term and for tendinopathies.

scholarly journals The Timing of Corticosteroid Injections after Shoulder Arthroscopy Affects Postoperative Infection Risk

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Michelle Elizabeth Kew ◽  
Jourdan M. Cancienne ◽  
James E. Christensen ◽  
Brian C. Werner
Keyword(s):  
Shoulder Arthroscopy ◽  
Corticosteroid Injection ◽  
Study Groups ◽  
Administrative Database ◽  
Control Group ◽  
Arthroscopic Shoulder Surgery ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Corticosteroid Injections ◽  
Private Payer

Objectives: To examine the association between the timing of post-operative corticosteroid injections with rates of post-operative infection in arthroscopic shoulder procedures. Methods: Private-payer and Medicare national insurance databases were queried for patients who underwent arthroscopic rotator cuff repair, debridement, or subacromial decompression. Patients who underwent corticosteroid injections within 1 month, 2 months, 3 months, or 4 months post-operatively were identified and compared to a matched control group that underwent the same surgeries without a postoperative steroid injection. ICD-9 and CPT codes were used to identify rates of post-operative infection within 90 days after injection for the study groups and controls. Multivariate binomial logistic regression analysis was used to compare groups and adjusted odds ratios (OR) and 95% confidence intervals were calculated with p< 0.05 considered significant. Results: A total of 3,946 patients were identified, including 264 patients who received an injection within 1 month after surgery, 471 within 2 months, 1,037 within, 1,874 within 4 months, and 2,640 matched controls. Compared to controls, patients who underwent a corticosteroid injection within 1 month postoperatively had a significantly higher rate of infection (PP: OR 2.63, p=0.014; MC: OR 11.2, p<0.0001). There were no differences in infection rates at all other time points: (p =0.264 -0.835). Conclusion: This study adds to the evidence suggesting caution when administering injections in the immediate post-operative period following arthroscopic shoulder surgery. Although causality cannot be determined on the basis of this administrative database review, we found a significant association between intra-articular ipsilateral corticosteroid injections administered 1 month post-operatively and an increased rate of post-operative infection, in both a Medicare and private payer patient cohort, when compared to a control patient group. [Table: see text][Table: see text]

scholarly journals Two-stage exchange Arthroplasty is a viable treatment for Periprosthetic joint infection in inflammatory diseases

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiao Jiang ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-Bo Hao ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Inflammatory Diseases ◽  
Joint Infection ◽  
Treatment Success ◽  
Serum Markers ◽  
Control Group ◽  
Two Stage ◽  
Fluid Analysis ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint

Abstract Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases. Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8 ± 1385.3*109/mL) and group C (1315.8 ± 1849.3*109/mL, p = 0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group. Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

scholarly journals Effectiveness of Blind & Ultrasound Guided Corticosteroid Injection in Impingement Syndrome

2015 ◽  
Vol 8 (7) ◽  
pp. 179 ◽  
Author(s):  
Shila Haghighat ◽  
Parisa Taheri ◽  
Mohsen Banimehdi ◽  
Arash Taghavi
Keyword(s):  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Medical Science ◽  
Impingement Syndrome ◽  
Control Group ◽  
Case Group ◽  
Ultrasound Guided ◽  
Shoulder Range Of Motion ◽  
Significant Difference ◽  
Corticosteroid Injections

<p>Local steroid injections are common for treatment of impingement syndrome. Corticosteroid injections methods are basically in two formats, blind or with image guidance. The aim of this study is to compare the effect of ultrasound-guided in comparison with blind corticosteroid injections in patients with impingement syndrome. This study is a randomized clinical trial study undertaken in patients with diagnosis of impingement syndrome done in Isfahan University of Medical Science clinics from February 2014 to February 2015. The number of all patients registered in the study is 48; and then 40 patients were allocated to either control group randomly which received blind steroid injection or case group that underwent ultrasound-guided steroid injection. The clinical symptoms were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire, Visual Analogue Scale (VAS) and shoulder range of motion (ROM) using goniometer at baseline and six weeks after the injection. Data analysis revealed a significant difference in the mean of the VAS, SPADI and shoulder ROM in both groups 6 weeks after intervention (P &lt; 0.05). Patients with ultrasound guided corticosteroid injection had statistically significant improvements in function and shoulder ROM (abduction, flexion) compared to blind injection group after 6 weeks (P&lt;0.05). There was not significant differences in pain (VAS) and internal and external rotation between these two groups (p&gt;0.05). Our findings suggest that US image guided can improve the shoulder function of patients with impingement syndrome, and thus can be considered in comprehensive care programs of these patients for fast speed of rehabilitation.</p>

scholarly journals Brucella Periprosthetic Joint Infection Involving Bilateral Knees with Negative Synovial Fluid Alpha-Defensin

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Abdullah Balkhair ◽  
Sultan Al Maskari ◽  
Shadin Ibrahim ◽  
Ibrahim Al Busaidi ◽  
Mohammed Al Amin ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Periprosthetic Infection ◽  
Joint Infection ◽  
Knee Joints ◽  
Human Brucellosis ◽  
Prosthetic Joint ◽  
Possible Cause ◽  
Microbiological Cure ◽  
Rule Out

Periprosthetic joint infection (PJI) due to Brucella is uncommon despite relatively high endemicity of human brucellosis and its osteoarticular predilection. We report a case of a 57-year-old woman with bacteraemic brucellosis complicated by Brucella periprosthetic infection of both knee joints occurring a decade after bilateral knee arthroplasty and associated with a negative synovial fluid alpha-defensin test. The patient was successfully treated with anti-Brucella therapy alone and without surgical revision, resulting in clinical and microbiological cure. We propose that Brucella should be considered as a possible cause of prosthetic joint infection in the appropriate clinical and epidemiological settings. A negative synovial fluid alpha-defensin (Synovasure AD test) should not be used as a rule-out test for Brucella PJI. Brucella PJI without radiological loosening may be treated conservatively and solely with antimicrobial therapy.

The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk

2019 ◽  
Vol 47 (4) ◽  
pp. 915-921 ◽  
Author(s):  
Michelle E. Kew ◽  
Jourdan M. Cancienne ◽  
James E. Christensen ◽  
Brian C. Werner
Keyword(s):  
Postoperative Period ◽  
Postoperative Infection ◽  
Shoulder Arthroscopy ◽  
Corticosteroid Injection ◽  
Study Groups ◽  
International Classification Of Diseases ◽  
Control Group ◽  
Level Of Evidence ◽  
Corticosteroid Injections ◽  
Private Payer

Background: Corticosteroid injections are sometimes used in the postoperative period after shoulder arthroscopy; however, a well-defined safety profile has not been established. Purpose: To examine the association between the timing of postoperative corticosteroid injections and rates of infection after shoulder arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Private payer and Medicare national insurance databases were queried for patients who underwent arthroscopic rotator cuff repair, debridement, or subacromial decompression. Patients who underwent corticosteroid injections within 1, 2, 3, or 4 months postoperatively were identified and compared with a matched control group that underwent the same procedures without a postoperative steroid injection. International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes were used to identify rates of postoperative infection within 90 days after injection for the study groups and controls. Multivariate binomial logistic regression analysis was used to compare groups, and adjusted odds ratios (ORs) and 95% CIs were calculated, with P < .05 considered significant. Results: A total of 3946 patients were identified, including 264 patients who received an injection within 1 month after surgery, 471 within 2 months, 1037 within 3 months, 1874 within 4 months, and 2640 matched controls. When compared with controls, patients who underwent a corticosteroid injection within 1 month postoperatively had a significantly higher rate of infection (private payer: OR, 2.63; P = .014; Medicare: OR, 11.2; P < .0001). There were no differences in infection rates at all other time points ( P = .264-.835). Conclusion: This study adds to the evidence suggesting caution when administering injections in the immediate postoperative period after shoulder arthroscopy. Although causality cannot be determined on the basis of this database review, the authors found a significant association between intra-articular corticosteroid injections administered 1 month postoperatively and an increased rate of postoperative infection in Medicare and private payer patient cohorts as compared with a control group.

scholarly journals Use of muscular flaps for the treatment of hip prosthetic joint infection: a systematic review

2021 ◽  
Vol 22 (S2) ◽  
Author(s):  
Giuseppe Rovere ◽  
Domenico De Mauro ◽  
Marco D’Orio ◽  
Camillo Fulchignoni ◽  
Maria Rosaria Matrangolo ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Periprosthetic Infection ◽  
Joint Infection ◽  
Management Option ◽  
Muscle Flaps ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Meta Analyses

Abstract Background Deep periprosthetic infection after total hip arthroplasty (THA) is a serious and challenging complication for the orthopedic surgeon. Muscular flaps may represent a valid management option for the treatment of this condition. We present a systematic literature review about the use of muscular flaps for the treatment of hip prosthetic joint infection. Methods The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-seven articles, out of 279 titles, were considered eligible for the full-text analysis. Finally 15 studies that met inclusion criteria were included in this review. Results Overall, 210 patients (49% males, 48.6% females and 2.4% not reported) suffering from THA infection treated with muscular flaps were collected. The mean age was 69.6 years. Mean follow-up, reported in all studies, was 3.3 years. The results presented by the different authors, highlight the effectiveness of muscular flaps for the treatment of periprosthetic infection, in terms of function, limb salvage, prevention of the recurrences, cost-effectiveness, and quality of life postoperatively. Conclusions Muscle flaps provide an excellent management option for patients with persistent infection after total hip arthroplasty.

scholarly journals Two-stage Exchange Arthroplasty is a Viable Treatment for Periprosthetic Joint Infection in Inflammatory Diseases

2020 ◽  
Author(s):  
Qiao Jiang ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-Bo Hao ◽  
Yong-Gang Zhou ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Inflammatory Diseases ◽  
Joint Infection ◽  
Treatment Success ◽  
Serum Markers ◽  
Control Group ◽  
Two Stage ◽  
Fluid Analysis ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint

Abstract Background Inflammatory diseases are chronic autoimmune systemic autoimmune diseases, which may increase the risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, to our best knowledge, few studies have studied the association between inflammatory diseases and subsequent failure after two-stage exchange reimplantation. The aims of this study were to identify the differences in (1) serum markers, synovial indicators and pathology results and (2) treatment outcomes following two-stage exchange arthroplasty between patients with or without inflammatory diseases.Methods A retrospective review of 184 patients with PJI who underwent two-stage revision from 2014 to 2018 was conducted. PJI was diagnosed by using the MSIS criteria. Serum biomarkers, synovial fluid, organism and pathology results at the time of the PJI diagnosis and reimplantation were compared between patients with or without inflammatory diseases. Treatment success was defined according to the Delphi-based consensus criteria; Kaplan-Meier survivorship curves of the patients were generated and compared. Results There was no difference in the biomarkers, pathology results or organism profile at the time of the PJI diagnosis. At reimplantation, the patients with inflammatory diseases generally had higher values of serum markers than those without inflammatory diseases. However, synovial white blood cell count was comparable in patients with inflammatory diseases (1142.8±1385.3*109/mL) and group C (1315.8±1849.3*109/mL, p=0.841). The total treatment success rate was 91.3% (92% for individuals with inflammatory diseases and 91.2% for the controls). The survivorship of the inflammatory disease group was comparable with that of the control group.Conclusion Two-stage exchange arthroplasty is a viable option for PJIs with inflammatory diseases. Synovial fluid analysis may be less affected by inflammatory diseases than serum markers did in the diagnosis persistent infection at reimplantation.

scholarly journals Near-fatal Periprosthetic Infection with Streptobacillus moniliformis: Case and Review

2020 ◽  
Vol 5 (1) ◽  
pp. 50-53
Author(s):  
Matthew Smallbones ◽  
Mohammed Monem ◽  
Marina Baganeanu ◽  
Michael Okocha ◽  
Rajesh Sofat
Keyword(s):  
Periprosthetic Infection ◽  
Close Contact ◽  
Joint Infection ◽  
Case Presentation ◽  
Streptobacillus Moniliformis ◽  
Prosthetic Joint ◽  
Standard Culture ◽  
Total Knee ◽  
Patient’S History ◽  
Relevant Factors

Abstract. Case presentation of a 66 year old female with penicillin hypersensitivity, who suffered late acute periprosthetic infection of her total knee replacement. After emergency surgery and admission to intensive care, the responsible organism was later identified as Streptobacillus moniliformis.This serves as the first documented case of Streptobacillus moniliformis prosthetic joint infection. As standard culture mediums provide an exceedingly low detection rate, 16S PCR should instead be used as the first line method of identification. As a result, its detection is largely dependent on clinicians recognising relevant factors within the patient's history, namely close contact with rodents. In a patient with penicillin hypersensitivity, carbapenems have demonstrated potential as an effective treatment strategy.

Sign in / Sign up

Export Citation Format

Share Document