Preoperative Corticosteroid Injections Research Articles

Retrospective Analysis of Patients Undergoing Arthroscopic Rotator Cuff Repair at a Single Institution Yields a 0.11% Postoperative Infection Rate

PurposeTo establish an infection rate following primary arthroscopic rotator cuff repair (ARCR) from a single institutional database and to ascertain whether there is a relationship between the use of preoperative corticosteroid injection (CSI) and the risk of postoperative infection.MethodsAll medical records at a single institution were retrospectively reviewed to identify patients who had undergone arthroscopic repair from January 2016 to December 2018. Patient charts were reviewed for CSI treatment within 6 months of surgery, superficial or deep infection within 2 months postoperatively, and specific treatment of the infection. Patient characteristics were summarized by descriptive statistics using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. A χ2 correlation analysis was performed to determine the association between receiving an injection and having an infection.ResultsA total of 1773 patients were included for analysis with an average age of 59.24 ± 9.4 years. The overall infection rate was 0.11% (2/1773 patients). Both patients were treated with oral antibiotics. Of the included patients, 616 had a preoperative CSI within 6 months of their surgery, and 102 injections were administered within 1 month of surgery. None of these patients had a postoperative infection. A χ2 correlation analysis showed a negligible relationship between preoperative injections and postoperative infection (φ = 0.02, χ2 = 0.84).ConclusionsThrough this single-institution, large cohort retrospective review, we found an overall 0.11% rate of postoperative infection following primary arthroscopic RCR. In addition, we found no correlation between the use of preoperative CSI ahead of elective ARCR at any time point and risk of developing a postoperative infection. Infection is uncommon following ARCR, and preoperative steroid injection did not increase infection risk in our study population.Level of EvidenceLevel IV, therapeutic case series.

Influence of Corticosteroid Injections on Postoperative Infections in Carpal Tunnel Release

Corticosteroid injections (CSIs) are commonly used in carpal tunnel syndrome; however, recent literature has demonstrated risk of postoperative infection associated with preoperative CSIs in other orthopedic fields. The aim of this study was to assess the relationship of CSIs and postoperative infection following carpal tunnel release (CTR). A single-center retrospective review was conducted from 2010 to 2019 to identify patients who underwent CTR with subsequent antibiotic prescription for chart-documented wound infection. A demographically-matched cohort of 100 patients was identified for comparison. Information on patient demographics, comorbidities, injection history, and presence of postoperative infection was collected. Thirty-nine patients (0.67% of all CTR patients) were identified with postoperative infections, 3 of which (0.05% of all CTR patients) were deep infections. In the infection cohort, 16 of 39 (41%) patients received an injection prior to surgery, whereas 16 of 100 (16%) patients in the control cohort received an injection. History of CSI was significantly more common in patients with postoperative infection, and patients in the infection cohort had a significantly shorter average time from injection to surgery by approximately 55 days. Corticosteroid injections in the preoperative period are associated with postoperative infection after CTR. Proximity of injection to time of surgery plays a role, although comorbidities, the corticosteroid dose, and frequency of injection require further study to determine risk contribution. Prognostic III.

The Effect of Corticosteroid Injections on Postoperative Infections in Trigger Finger Release.

Corticosteroid injections have proven benefit in the treatment of symptomatic trigger finger; however, the immune system and tissue repair modulating properties of corticosteroids justify further consideration in surgical candidates. The aim of this study was to assess the relationship between corticosteroid injections and postoperative infection in trigger finger release. A single-center retrospective review was conducted of patients seen from 2010 to 2019 to identify those who underwent trigger finger release with subsequent antibiotic prescription for chart-documented wound infection. A demographic matched cohort of 100 patients was identified for comparison. Preoperative corticosteroid injection history including timing, frequency, and dose was collected for all patients. Patient demographics, comorbidities, and presence of postoperative infection were collected from patient medical records. Superficial infection was defined as those requiring antibiotics for resolution without return to the operating room; deep infection was defined as infections that required irrigation and debridement. Of 3234 patients who underwent trigger finger release, 58 (1.8%) were identified with postoperative infections, 6 (0.2%) of which were deep infections. History of corticosteroid injection was significantly more common in patients with postoperative infection. Compared with an age-matched, gender-matched, and body mass index-matched cohort, patients with postoperative infection had significantly increased rate of diabetes mellitus at 34.5% to 19% (P = .04). While corticosteroid injection in the preoperative period is associated with a higher rate of postoperative infection, the time before surgery and the corticosteroid dose do not appear to have an effect.

Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant.

There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. In all, 81.2% of patients reported that their foot was "much improved" (55.2%) or "improved" (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were "extremely satisfied" (41.7%) or "satisfied" (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. Level IV: Retrospective case series.

Preoperative Corticosteroid Injections Demonstrate a Temporal and Dose-Dependent Relationship with the Rate of Postoperative Infection Following Total Hip Arthroplasty

BackgroundCorticosteroid injections (CSI) are commonly used for the treatment of osteoarthritis of the hip. There is concern, however, that these injections may increase the risk of postoperative infection if a subsequent total hip arthroplasty (THA) is performed. The purpose of the present investigation is to determine the relationship between CSI and the risk of periprosthetic joint infection (PJI) and surgical site infections (SSIs) following THA. MethodsThe PearlDiver database was reviewed for patients undergoing THA from 2011 to 2018. Patients with unilateral hip osteoarthritis who received an intra-articular hip CSI prior to ipsilateral THA were matched in a sequential 1:1 fashion based on age, gender, and Charlson Comorbidity Index with THA patients who did not receive an injection in the preoperative period. PJI and SSI within 6 months of the surgical procedure were recorded. Statistical analysis included chi-squared test and multivariate logistic regression. Results were considered significant at P < .05. ResultsIn total, 29,058 patients underwent a hip CSI within 6 months prior to THA. CSI within 4 months of surgery was associated with a higher incidence of PJI at 6-month follow up (1.6% vs 1.1%, P = .040). An injection within 1 month of surgery corresponded to a higher odds of PJI (odds ratio [OR] 1.97) than an injection 4 months prior to surgery (OR 1.24). Furthermore, the quantity of CSI administered within the 3 months prior to THA demonstrated a dose-dependent relationship, with each subsequent injection increasing odds of PJI (OR 1.45-3.59). A similar relationship was observed for SSI. ConclusionThere appears to be both a time and dose-dependent association of hip CSI and PJI following THA. Surgeons should consider delaying elective THA if a CSI has been administered within the 4 months prior to the planned procedure.

A Safe Interval between Preoperative Intra-articular Corticosteroid Injections and Subsequent Knee Arthroscopy.

The purpose of this study is to evaluate the influence of intra-articular corticosteroid injections prior to knee arthroscopy on the rate of postoperative infection and define a safe timing interval between intra-articular corticosteroid injections and subsequent knee arthroscopy. The PearlDiver Database was used to identify patients who underwent a knee arthroscopy from 2007 to 2017. Patients were sorted into an injection cohort if they received any intra-articular corticosteroid injections within 6 months before surgery and a control cohort if they received no such injections. The injection cohort was then stratified into subgroups based on the timing of the most recent injection. We identified two types of postoperative infection in the 6 months following surgery: a broad definition of infection using knee infection diagnoses, and a narrow definition of infection requiring surgical treatment. The effects of the timing of preoperative corticosteroid injections on the rates of postoperative infection were investigated. The rate of broadly defined postoperative infection was significantly higher in the 0 to 2 weeks injection group (6.90%, 20/290) than the control group (2.01%, 1,449/72,089, p < 0.001; odds ratio [OR]:3.61 [95% confidence interval [CI]: 2.29, 5.70]). We observed a significant difference regarding the rate of narrowly defined postoperative infection requiring surgical treatment between the 0 and 2 weeks injection group (1.38%, 4/290) and the control group (0.27%, 192/72,089, p < 0.001, OR:5.24 [95% CI: 1.94, 14.21]). No significant differences were observed between other subgroups and the control group in both types of postoperative infection. Intra-articular corticosteroid injections within 2 weeks of knee arthroscopy were statistically significantly associated with higher rates of postoperative infection. This is a Level III, retrospective comparative study.

Increased Use of Intra-Articular Steroid Injection to Treat Osteoarthritis is Associated With Chronic Opioid Dependence After Later Total Knee Arthroplasty But Not Total Hip Arthroplasty

BackgroundIntra-articular (IA) injections of corticosteroid (CO) and hyaluronic acid (HA) are commonly used for osteoarthritis. The efficacy of these interventions is controversial. Furthermore, research regarding the potential association of IA injection with later postoperative pain trajectories is lacking. MethodsWe performed analysis on Truven Health MarketScan database (2012-2016) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Trends over time were assessed. Multivariable logistic regression analyses were executed to evaluate the impact of IA injections on postoperative chronic opioid use. ResultsPreoperative CO and HA injections decreased throughout the study period in both THA and TKA. Preoperative CO and HA injections, regardless of frequency, had no significant impact on the odds of THA patients becoming chronic opioid users postoperatively. TKA patients who had 1 CO injection in the year before surgery experienced lower odds of postoperative chronic opioid use (odds ratio [OR], 0.89; 95% confidence interval [95% CI], 0.82-0.97), whereas patients who had 2 or more CO injections experienced significantly greater odds (OR, 1.14; 95% CI, 1.04-1.24). TKA patients who received 2 or more HA injections before surgery had significantly lower odds of chronic opioid use (OR, 0.90; 95% CI, 0.81-0.99). ConclusionThe utilization of IA injections in patients with hip and knee osteoarthritis appears to be decreasing over time. TKA patients who received 2 or more preoperative CO injections experienced greater odds of chronic opioid utilization, whereas TKA patients with 2 or more HA injections in the year before surgery had decreased odds of chronic opioid use.

Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection

To determine the risk for infection in trigger finger release surgery after preoperative corticosteroid injection. We retrospectively evaluated all patients undergoing trigger finger release by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, trigger finger(s) operated on, presence of a prior corticosteroid injection, date of most recent corticosteroid injection, postoperative signs of infection, and need for surgery owing to deep infection. Superficial infection was defined per Centers for Disease Control criteria. Deep infection was defined as the need for surgery related to a surgical site infection. In this cohort of 2,480 fingers in 1,857 patients undergoing trigger release surgery, 53 (2.1%) developed an infection (41 superficial [1.7%] and 12 deep [0.5%]). Before surgery, 1,137 fingers had no corticosteroid injection. These patients developed 1 deep (0.1%) and 17 superficial (1.5%) infections. In contrast, 1,343 fingers had been given a corticosteroid injection before surgery. These patients developed 11 deep (0.8%) and 24 superficial (1.8%) infections. Median time from corticosteroid injection to trigger release surgery was shorter for fingers that developed a deep infection (63 days) compared with those that developed no infection (183 days). The risk for developing a deep infection in patients who were operated on within 90 days of an injection (8 infections in 395 fingers) was increased compared with patients who were operated on greater than 90 days after an injection (3 infections in 948 fingers). Preoperative corticosteroid injections are associated with a small but statistically significantly increased rate of deep infection after trigger finger release surgery. The risk for postoperative deep infection seems to be time dependent and greater when injections are performed within 90 days of surgery, especially in the 31- to 90-day postinjection period. Therapeutic IV.

Preoperative corticosteroid joint injections within 2 weeks of shoulder arthroscopies increase postoperative infection risk

There is currently no consensus regarding the safe timing interval between corticosteroid shoulder injections and future shoulder arthroscopies. Our study assessed the relationship between preoperative corticosteroid injection timing and shoulder arthroscopy infectious outcomes. We used an insurance database to identify and sort all shoulder arthroscopy patients by corticosteroid shoulder injection history within 6 months before surgery. Patients who received injections were stratified by the timing of their most recent preoperative injection. The overall infection rate and rate of severe infections requiring treatment through intravenous antibiotics or surgical débridement in the 6-month postoperative period were compared using χ2tests between the injection cohorts and a control group of patients defined as those with no injection history. We identified 50,478 shoulder arthroscopy patients, of whom 4115 received injections in the 6-month preoperative period. We found a significant increase in both the overall infection rate (P < .0001) and severe infection rate(P < .0001) in patients who received injections within 2 weeks before surgery (n = 79; 8.86% and 6.33%, respectively) compared with those who received no injections in the 6-month preoperative period (n = 46,363; 1.56% and 0.55%, respectively). No other significant differences were observed. Our results suggest that in patients who have received corticosteroid injections, shoulder arthroscopic procedures may be safely performed after at least 2 weeks has passed since the most recent injection to minimize the risk of postoperative infection. In addition, procedures performed within 2 weeks of an injection may increase the risk of postoperative infection.

Impact of Septated First Dorsal Compartments on Symptomatic de Quervain Disease.

The authors conducted this study to determine whether septation of the first dorsal compartment is more prevalent in de Quervain tenosynovitis, and whether this contributes to failure of corticosteroid injection therapy. A retrospective review of 79 consecutive patients (85 wrists) with symptomatic de Quervain tenosynovitis treated with surgical release was performed. The number of corticosteroid injections performed preoperatively and the presence of first dorsal compartment septation determined intraoperatively were recorded. Correlation between the number of steroid injections and the presence of septation was evaluated. In addition, 48 matched cadaver upper extremities (96 wrists) that had not previously undergone surgery for de Quervain disease were evaluated for the presence of first dorsal compartment septation. The prevalence of septation was compared between matched wrists and against the surgically treated clinical cohort. In the clinical cohort, 61.2 percent of wrists contained a septated first dorsal compartment. There was no correlation between the presence of a septated first dorsal compartment and the number of steroid injections before surgical release. In the cadaver portion of the study, 72.9 percent of wrists contained septa. There was no significant difference in the prevalence of septated first dorsal compartments between groups. In the present study, the majority of wrists contained a septated first dorsal compartment, with no difference in the prevalence of septa between surgically treated patients and a cadaver sample that had not undergone prior surgical release. Furthermore, there was no correlation between the presence of septa and the number of preoperative corticosteroid injections administered. Risk, III.

The Timing of Injections Prior to Arthroscopic Rotator Cuff Repair Impacts the Risk of Surgical Site Infection.

Corticosteroid injections are a common treatment for rotator cuff tears. Because of concerns of infection, a surgical procedure is often delayed following injections. The purpose of this investigation was to determine if there is a temporal relationship between corticosteroid injections and the risk of surgical site infection after arthroscopic rotator cuff repair. We hypothesized that the incidence of surgical site infection is higher in patients who received a preoperative injection and this relationship exists in a temporal manner as those patients receiving an injection closer to the operative date have a higher risk of infection. The PearlDiver database was reviewed for patients undergoing arthroscopic rotator cuff repair from 2007 to 2016. Patients were stratified into 2 cohorts: those undergoing arthroscopic rotator cuff repair within 1 year of injection (n = 12,060), and those undergoing arthroscopic rotator cuff repair without prior injection (n = 48,763). Patients with preoperative injections were further stratified by the duration in months that the injection was performed prior to the surgical procedure. Surgical site infection within 6 months of the surgical procedure was recorded. Statistical analysis included chi-square and multivariate binomial logistic regression analyses to identify risk factors for surgical site infection. Results were considered significant at p < 0.05. There was no significant difference in the incidence of surgical site infection in patients receiving a shoulder injection at 0.7% compared with the control cohort at 0.8% (odds ratio [OR], 0.9 [95% confidence interval (CI), 0.7 to 1.1]; p = 0.2). However, patients receiving an injection within 1 month prior to operative management had a significantly higher rate of surgical site infection overall at 1.3% compared with the control group at 0.8% (OR, 1.7 [95% CI, 1.0 to 2.9]; p = 0.04). On multivariate analysis, male sex (OR, 1.7 [95% CI, 1.4 to 1.9]; p = 0.001), obesity (OR, 1.4 [95% CI, 1.2 to 1.6]; p < 0.001), diabetes (OR, 1.3 [95% CI, 1.1 to 1.5]; p < 0.001), smoking status (OR, 1.7 [95% CI, 1.4 to 1.9], p < 0.001), and preoperative corticosteroid injections within 1 month of the surgical procedure (OR, 2.1 [95% CI, 1.5 to 2.7]; p < 0.001) were independent risk factors for development of a surgical site infection. Injections within 1 month of arthroscopic rotator cuff repair significantly increases the risk of surgical site infection. However, there is no increased risk of infection if the surgical procedure is delayed by 1 month following an injection. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears

Do Preoperative Corticosteroid Injections Increase the Risk for Infections or Wound Healing Problems After Spine Surgery?: A Swiss Prospective Multicenter Cohort Study.

A prospective multicenter cohort study. This study evaluates the risk for surgical site infections (SSIs) or wound healing problems (WHPs) in patients who underwent corticosteroid injection before lumbar decompression surgery. Corticosteroid injections are often used for the treatment of the degenerated spine. However, their well-known immunosuppressive effects could increase the risk for local infections, particularly if a surgical intervention follows the injection rapidly. The Swiss Lumbar Stenosis Outcome Study (LSOS), which is a prospective multicenter cohort study of patients with symptomatic lumbar spinal stenosis, was used as database. Of 743 patients, 422 patients underwent surgery and were eligible for the study. Ten patients (2.4%) were revised for either SSIs (n = 6) or WHPs (n = 4). A control group (n = 19) was constructed matched according to age, sex, diabetes, and body mass index (BMI). Odds ratios (ORs) were calculated by using a conditional logistic regression model to quantify the risk of SSI or WHP after preoperative corticosteroid injection. Subgroup analysis was performed for patients with injection within 0 to 3 months before surgery, 0 to 6 months before surgery, or any injection at all before surgery. Within this cohort, no significant association could be found between preoperative corticosteroid injection and postoperative SSI or WHP in patients with corticosteroid injections within 0 to 3 months before surgery [OR = 0.36, 95% confidence interval (95% CI) 0.04-3.22], 0 to 6 months before surgery (OR = 0.69 95% CI 0.14-3.49), or any time before surgery (OR = 0.43, 95% CI 0.04-3.22). Within the here investigated cohort, the risk of SSIs or WHPs following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously, and is the subject of further research. 2.

Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair?

BackgroundRotator cuff tears are associated with capsular contraction and stiffness that should be restored before surgical repair. Corticosteroid injections (CSIs) are frequently used as conservative treatments before surgical repair. This study aimed to determine the influence of preoperative and postoperative CSIs on clinical and anatomic outcomes after rotator cuff repair.MethodsThe authors analyzed the records of 257 patients who had arthroscopic rotator cuff repair, of whom 212 were evaluated at 3.1 ± 1.0 years (median, 2.9 years; range, 1.4-7.1 years) by clinical (Constant score) and ultrasound (Sugaya classification) examinations. Univariable and multivariable regressions were performed to determine associations between outcomes and administration of preoperative and postoperative CSIs, patient characteristics, and tendon characteristics.ResultsThe Constant scores improved from 56.4 ± 15.1 to 80.8 ± 12.5. Multivariable regression confirmed that postoperative scores were associated with postoperative CSIs (P < .001), preoperative scores (P < .001), gender (P < .001), and fatty infiltration (P < .005). Retears (Sugaya types IV-V) were observed in 27 shoulders (13%). Multivariable regression clarified that retear rates were associated only with postoperative CSIs (P = .007) and stage 3 fatty infiltration (P = .001). Adjusting for confounders, an additional postoperative CSI would decrease scores by 4.7 points and double retear risks.DiscussionPreoperative CSIs had no influence on clinical scores and retear rates, whereas postoperative CSIs were associated with lower scores and more retears. Although we can infer that preoperative CSIs do not affect outcomes, we cannot determine whether postoperative CSIs compromised outcomes or were administered in patients who had already poor outcomes. Our findings may resolve controversies about the administration of preoperative CSIs.

Arthroscopic 360-Degree Capsular Release for Idiopathic Adhesive Capsulitis in the Lateral Decubitus Position

Objectives:Idiopathic glenohumeral adhesive capsulitis impairs patient motion and function. If conservative management fails, arthroscopic capsular release is classically performed in the beach-chair position with incapsule release and manipulation under anesthesia. We report outcomes following arthroscopic 360-degree capsular release in lateral decubitus position followed by limited manipulation to confirm restoration of range of motion.Methods:A retrospective case series of patients undergoing arthroscopic capsular release in the lateral decubitus position for idiopathic adhesive capsulitis with minimum 2-year follow-up was conducted. Patient demographics, preoperative range of motion (ROM), postoperative ROM, and postoperative outcome scores were recorded. Complications and reoperations were recorded. Paired t-tests were used to compare preoperative and postoperative ROM, with p<0.05.Results:Overall, 43 patients were identified, of which 10 were excluded due to posttraumatic etiology. Of the remaining 33 patients, 27/33 (81.8%) completed a minimum follow-up of 2-years. The mean age was 54.8+/-7.4 years and 73% female, with duration of symptoms 16.2+/-21.0 months (range 2 to 125). Hypothyroidism was present in 6% and diabetes present in 33%. Pre-operatively, patients had 1.8+/-1.1 preoperative corticosteroid injections (range 0-5). Active forward flexion improved from 115.0+/-21.9 degrees to 156.2+/-16.1 degrees at final follow-up (mean difference 41.2, 95% confidence interval [33.7,48.7], p<0.001). Active external rotation with the arm adducted improved from 28.1+/-16.3 degrees preoperatively to 56.8+/-15.7 degrees at final follow-up (mean difference 27.7, 95% confidence interval [19.1,36.3], p<0.001). Significant range of motion improvements were seen even as early as 2-weeks postoperative (Figure). Overall, final outcomes were excellent, including VAS pain of 0.2+/-0.5, SANE 96.3+/-4.9, SST 11.3+/-1.2, and ASES 97.0+/-4.7. There were no revision surgeries and no complications.Conclusion:Arthroscopic 360-degree capsular release in the lateral decubitus position for idiopathic adhesive capsulitis results in a significant early and lasting improvement in range of motion, excellent functional outcomes, and low revision and complication rates.

Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears.

Subacromial corticosteroid injections (CSI's) are a common non-surgical treatment for rotator cuff tears. Few studies have assessed the effects of pre-operative CSI's on postoperative functional outcomes. A retrospective analysis was conducted of 132 patients with high-grade, partial-thickness rotator cuff tears (PTRCT's). The subjects were divided into two groups based on whether they received a CSI or not. The CSI group was further divided into three subgroups based on when they received a pre-operative injection: 0-3 months, 3-6 months, >6 months before surgery. The Visual Analog Scores (VAS), American Shoulder and Elbow Surgeon scores (ASES), and Constant scores were recorded prior to surgery and at a one-year post-operative follow-up appointment for each subject. Patients who received a pre-operative CSI (n=92) improved significantly more than the non-injection group (n=40) in all outcome measures. The 0-3 months injection subgroup experienced a significant increase in ASES and Constant score (p=0.019 and 0.014, respectively) compared to the other two subgroups, but the VAS score decrease only trended toward significance (p=0.091). The sample as a whole experienced significant improvement in all three outcome measures. Patients undergoing arthroscopic repair of a high-grade PTRCT may benefit from a pre-operative CSI 0-3 months before surgery. IIb.

The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study.

Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty. There is limited evidence to suggest how frequently false-positive cultures occur. The purpose of this prospective controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery. Patients undergoing an open deltopectoral approach to the shoulder were prospectively enrolled. Patients with a history of shoulder surgery or any concern for active or previous shoulder infection were excluded. Three pericapsular soft-tissue samples were taken from the shoulder for bacterial culture and were incubated for fourteen days. A sterile sponge was also analyzed in parallel with the tissue cultures. In addition, similar cultures were obtained from patients who had undergone previous shoulder surgery. Overall, 20.5% of surgeries (twenty-four of 117) yielded at least one specimen removed for culture that was positive for bacterial growth, and 13.0% of sterile control specimens (seven of fifty-four) had positive culture growth (p = 0.234). P. acnes represented 83.0% of all positive cultures (thirty-nine of forty-seven) at a median incubation time of fourteen days. Among the subjects who had not undergone previous surgery, 17.1% (fourteen of eighty-two) had at least one positive P. acnes culture. Male sex was univariably associated with a greater likelihood of bacterial growth (p < 0.01), and patients who had not undergone previous surgery and had received two or more preoperative corticosteroid injections had a higher likelihood of bacterial growth (p = 0.047). The clinical importance of positive P. acnes cultures from specimens obtained from open shoulder surgery remains uncertain. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth on culture and are risk factors that merit further investigation. Previously reported incidences of positive P. acnes culture results from specimens from primary and revision shoulder arthroplasty may be overestimated because of a substantial level of culture contamination. P. acnes is isolated via culture at a substantial rate from shoulders undergoing a deltopectoral approach. The clinical importance of culture growth by this low-virulence organism still remains uncertain. Further study is necessary to more specifically characterize culture growth by P. acnes as an infection, commensal presence, or contaminant.

Preoperative corticosteroid injections are associated with worse long-term outcome of surgical carpal tunnel release

Background and purpose Failed closed treatment of carpal tunnel syndrome (CTS) is often followed by surgery. We investigated whether preoperative steroid injections could have a negative effect on the long-term outcome of the operation.Patients and methods 174 hands (164 patients) were operated on by a single surgeon at Tartu University Hospital in 2005. The patients were interviewed by telephone 5–6 years after the operation. Self-reported data were gathered retrospectively concerning the number of steroid injections received before the surgery and the perceived regression of symptoms (on a 100-point numeric rating scale) at the time of interview. The patients were also asked about the presence of specific symptoms of CTS if regression of their symptoms had not been complete.Results 93 of the 174 hands had complete regression of symptoms. Each additional injection was associated with an increased risk of occurrence of pain (RR = 1.1, 95% CI: 1.02–1-2), paresthesiae (RR = 1.1, CI: 1.1–1.2), and nocturnal awakenings (RR = 1.2, CI: 1.1–1.3). There was a weak association between the number of injections and the score given to regression of symptoms.Interpretation This is the first study to indicate that patients who received a greater number of local steroid injections preoperatively were more likely to have postoperative complaints associated with CTS.