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Soares DJ, Bowhay A, von Haven HN, Ugarte AJ, Blevins LW, Birusingh RJ, Kechriotis C, Yi CH. Needle Microcores: Can They Pose an Occlusive Threat with Nonparticulate Injections? Plast Reconstr Surg 2024; 153:326e-330e. [PMID: 37010461 DOI: 10.1097/prs.0000000000010508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
SUMMARY The incidence of vascular occlusion injuries has risen substantially along with the increasing popularity of cosmetic injectables. Among these occurrences, instances of soft-tissue ischemic events following the injection of nonparticulate solutions, such as botulinum, represent an enigmatic etiology that has yet to be fully understood. One hypothesized mechanism of injury underlying these events relates to the accidental capture and intravascular ejection of needle microcores, defined as submillimeter tissue fragments trapped by the beveled lumen of a needle during conventional injections. To test this hypothesis, the authors conducted a cytologic evaluation of dermal remnants incidentally captured by 31-G tuberculin needles following repeated injections into postrhytidectomy skin fragments. Their findings revealed the presence of dermal tissue microcores ranging from 100 to 275 μm in diameter with an overall microcoring incidence of 0.7%. These findings confirm the ability of ultrafine needles, commonly used in botulinum injections, to produce tissue microcores that may serve as causative agents of vascular occlusion with nonparticulate solutions. Awareness of this mechanism of injury may be of benefit in the early recognition and management of these rare occurrences. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Danny J Soares
- From the American Foundation for Aesthetic Medicine
- College of Medicine, University of Central Florida
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Durst CR, Rezzadeh KT, Than JP, Rajaee SS, Spitzer AI. Intra-Articular Corticosteroid Injections Into a Preexisting Total Knee Arthroplasty are Associated With Increased Risk of Periprosthetic Joint Infection and Revision. Arthroplast Today 2023; 24:101237. [PMID: 38023641 PMCID: PMC10679886 DOI: 10.1016/j.artd.2023.101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aims to determine the risks of periprosthetic joint infection (PJI) and revision associated with injecting a preexisting total knee arthroplasty (TKA) with intra-articular corticosteroids (IACSs). Methods The PearlDiver database was used to identify patients who underwent elective, primary TKA between 2015 and 2019. Patients who received IACS injections into the ipsilateral knee within 1 year after their primary TKA were matched 2:1 on age, gender, and Charlson comorbidity index and compared to a no-injection control group. The incidence of PJI at 1 year postoperatively and revision at 2 years postoperatively were compared between groups. Results A total of 27,059 patients were in the injection cohort and 54,116 patients in the control cohort. The overall PJI rate was 1.3% in the injection cohort and 0.8% in the control cohort (P < .001). The rate of PJI increased with the number of post-TKA IACS injections received: 1 injection (1.3%), 2 injections (1.4%), and >3 injections (1.8%) (P < .001 for all, compared to controls). The revision rate was 3.1% in the injection cohort and 1.3% in the control cohort (P < .001). Revision rates increased with the number of post-TKA IACS injections received: 1 injection (2.5%), 2 injections (4.2%), and >3 injections (7.3%) (P < .001 for all, compared to controls). Conclusions IACS injections into a preexisting TKA are associated with an incremental increased risk of prosthetic joint infection and revision. Considering the potential deleterious impact of PJI and complexity of revision procedures, IACS injections into a preexisting TKA should be strongly discouraged.
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Affiliation(s)
- Caleb R. Durst
- Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, CA, USA
| | - Kevin T. Rezzadeh
- Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, CA, USA
| | - Justin P. Than
- Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, CA, USA
| | - Sean S. Rajaee
- Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, CA, USA
| | - Andrew I. Spitzer
- Department of Orthopedic Surgery, Cedars-Sinai Medical System, Los Angeles, CA, USA
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Central Forehead Ischemic Skin Injury following Glabellar Botulinum: A Paradigm Microshift? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4865. [PMID: 36910736 PMCID: PMC10005824 DOI: 10.1097/gox.0000000000004865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/27/2023] [Indexed: 03/12/2023]
Abstract
Vascular occlusion events have surged in incidence due to the increased popularity of cosmetic injectables. Ostensibly, treatments that involve nonparticulate solutions, such as botulinum, have traditionally been thought to carry no risk of vaso-occlusive complications. In this article, we report the first published instance of a suspected ischemic skin injury after botulinum injection to the glabella and surmise on the potential etiological mechanisms that may underlie these rare occurrences.
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Labmayr V, Eckhart FJ, Smolle M, Klim S, Fischerauer SF, Bernhardt G, Seibert FJ. [Sterile puncture of large joints]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:65-80. [PMID: 36648491 PMCID: PMC9894986 DOI: 10.1007/s00064-022-00786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory. INDICATIONS The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions. CONTRAINDICATIONS If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants. SURGICAL TECHNIQUE Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas. POSTOPERATIVE MANAGEMENT Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma. FACTS If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.
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Affiliation(s)
- Viktor Labmayr
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | | | - Maria Smolle
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Sebastian Klim
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Stefan Franz Fischerauer
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Gerwin Bernhardt
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Franz Josef Seibert
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
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Bains SS, Chen Z, Sax OC, Naziri Q, Nace J, Delanois RE. Delaying Total Knee Arthroplasty More than 4 Weeks after Intra-Articular Knee Injection Does Not Further Decrease Risk of Septic Revision. J Knee Surg 2022; 35:1511-1517. [PMID: 36538938 DOI: 10.1055/s-0042-1757596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hyaluronic acid (HA) and corticosteroid (CS) injections are utilized in symptom management for patients with osteoarthritis. However, contamination of the joint may increase the risk of infection following total knee arthroplasty (TKA). Therefore, the purpose of this study was to examine 90-day surgical site infection (SSI) and manipulation under anesthesia (MUA) as well as up to 2-year prosthetic joint infection (PJI) in intra-articular knee injection recipients prior to TKA compared with patients who did not have knee injections. We specifically assessed (1) timing of HA and CS prior to TKA; (2) type of intra-articular knee injection; as well as (3) associated risk factors. We queried a national database to identify patients who underwent primary TKA from September 2015 to October 2020 (n = 1.5 million). Patients with prior knee injections were stratified to five cohorts: HA within 4 weeks (n = 140), HA 4 to 6 weeks prior (n = 337), CS within 4 weeks (n = 2,344), CS 4 to 6 weeks (n = 2,422), and a no injection, control, cohort prior to TKA (n = 5,000). Bivariate chi-square analyses of outcomes were conducted, and multivariate regressions were used to adjust for comorbidities and assess associated risk factors. The adjusted analysis showed a significant risk in infection for patients receiving an injection within 4 weeks of TKA (p < 0.023) and showed no difference in type of injection (p > 0.050). Additionally, SSIs were increased 1.58 times in the CS within 4 weeks of TKA cohort (p = 0.023). However, no difference in MUA risk was shown at 90-day postoperative (p > 0.212). Furthermore, tobacco use was identified as a risk factor that further increased likelihood of PJI. Intra-articular knee injection less than 4 weeks before TKA increased the risk for PJI; however, past 4 weeks did not confer infection risk. Tobacco use was identified as an associated risk factor that further increased likelihood for PJI. These results highlight the need for surgeons to wait 4 weeks between knee injection and TKA to decrease risk of septic revision.
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Affiliation(s)
- Sandeep S Bains
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Oliver C Sax
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Qais Naziri
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - James Nace
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Clinical Validation of Rapid Gout Detection Method and Kit. Methods Protoc 2021; 4:mps4040069. [PMID: 34698258 PMCID: PMC8544494 DOI: 10.3390/mps4040069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Gout is an inflammatory arthritis, which causes intense, acute pain due to the buildup of uric acid crystals in synovial fluid. The gold standard for gout diagnosis consists of synovial fluid analysis by polarized light microscopy, which is costly, time-intensive, and technique-dependent, therefore meriting a more efficient, inexpensive, and accessible method for diagnosis. We previously developed and validated a novel colorimetric gout detection method and device based on the reduction of silver nitrate by uric acid; here, we clinically validated our method and device using arthroscopically obtained synovial fluid samples from gout patients. We successfully identified uric acid crystals in clinical samples via our colorimetric method, visualized uric acid crystals in synovial fluid via handheld microscopy, and determined that silver nitrate stain did not interfere with the microscopic visualization of uric acid crystals necessary for diagnosis. We also developed and validated a method of processing turbid clinical samples for use in our device to prevent the obscuration of uric acid crystals by suspended material. Our method and device will clinically facilitate the immediate colorimetric diagnosis of gout and the subsequent bedside visualization of uric acid crystals in both ideal and turbid synovial fluid samples, allowing for a point-of-care diagnosis of gout.
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Cheok T, Jennings M, Aprato A, Jayasekera N, Jaarsma RL. Safety of intraarticular corticosteroid injection preceding hip and knee arthroplasty: a systematic review and meta-analysis amid resolving COVID-19 arthroplasty restrictions. J Hip Preserv Surg 2021; 8:215-224. [PMID: 35578716 PMCID: PMC8499814 DOI: 10.1093/jhps/hnab064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/12/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023] Open
Abstract
Intraarticular corticosteroid injection (ICSI) is a widely practiced management for hip
and knee osteoarthritis. Imposed delays to arthroplasty during coronavirus disease 2019
pandemic have led us to postulate that many patients have opted for recent ICSI. We
compared the odds of prosthetic joint infection (PJI) in patients who were or were not
administered ICSI within 12 months prior to hip or knee arthroplasty. A systematic
search of PubMed, Embase, The Cochrane Library and Web of Science was performed in
February 2021, with studies assessing the effect of ICS on PJI rates identified. All
studies, which included patients that received ICSI in the 12 months prior to primary
hip and knee arthroplasty, were included. In total 12 studies were included: four
studies with 209 353 hips and eight studies with 438 440 knees. ICSI administered in the
12 months prior to hip arthroplasty increased the odds of PJI [odds ratio (OR) = 1.17,
P = 0.04]. This was not the case for knees. Subgroup analysis showed
significantly higher odds of PJI in both hip [OR = 1.45, P = 0.002] and
knee arthroplasty [OR = 2.04; P = 0.04] when ICSI was within the
preceding 3 months of surgery. A significantly higher odds of PJI were seen in patients
receiving ICSI within the 12 months prior to hip arthroplasty. Subgroup analysis showed
increased odds of PJI in both hip and knee arthroplasty, in patients receiving ICSI
within 3 months prior to their arthroplasty. We recommend delaying knee arthroplasty for
at least 3 months after ICSI and possibly longer for hip arthroplasty.
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Affiliation(s)
- Tim Cheok
- Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, Northern Territory 0870, Australia
| | - Matthew Jennings
- Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, Northern Territory 0870, Australia
| | - Alessandro Aprato
- Traumatologic Hospital, University of Turin, via Gianfranco Zuretti, 29, Turin 10126, Italy
| | - Narlaka Jayasekera
- Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, Northern Territory 0870, Australia
| | - Ruurd L Jaarsma
- Department of Trauma and Orthopaedics, Alice Springs Hospital, 6, Gap Road, Northern Territory 0870, Australia
- Department of Trauma and Orthopaedics, Flinders drive Medical Centre, Bedford Park, Adelaide, South Australia 5042, Australia
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Kluger N. Is it safe to vaccinate within a tattoo? Ann Dermatol Venereol 2021; 148:256-258. [PMID: 34218936 PMCID: PMC8248893 DOI: 10.1016/j.annder.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- N Kluger
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Meilahdentie 2, 00029 Helsinki, Finland; "Tattoo" consultation, Department of dermatology, Bichat-Claude-Bernard Hospital, 46, rue Henri-Huchard, 75018 Paris, France.
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Crawford AM, Grisdela PT, Maguire JH, von Keudell AG. Septic Iliopsoas Bursitis After Intra-articular Methylprednisolone Injection to the Hip: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00127. [PMID: 34161307 DOI: 10.2106/jbjs.cc.21.00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the case of a 74-year-old man who developed severe hip pain several days after an intra-articular methylprednisolone injection to his right hip. Culture of the ipsilateral iliopsoas bursa revealed a Staphylococcus lugdunensis infection, which was successfully eradicated through irrigation and debridement as well as antibiotics. CONCLUSION Infection after hip injection is a known theoretical risk but is rarely reported in the literature. We present a case of septic bursitis after corticosteroid injection. Readers should be mindful that these complications do occur in clinical practice and portend significant morbidity.
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Affiliation(s)
- Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, Massachusetts
| | - Philip T Grisdela
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, Massachusetts
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Madden GR, Poulter MD, Crawford MP, Wilson DS, Donowitz GR. Case report: Anaerobiospirillum prosthetic joint infection in a heart transplant recipient. BMC Musculoskelet Disord 2019; 20:301. [PMID: 31238924 PMCID: PMC6593573 DOI: 10.1186/s12891-019-2684-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background We report a case of prosthetic hip joint infection in a heart transplant recipient due to Anaerobiospirillum succiniciproducens, a genus of spiral-shaped curved anaerobic gram-negative rod which colonizes the gastrointestinal tract of cats and dogs. Invasive infections in humans are rare and typically occur in immunocompromised hosts. Case presentation A 65-year-old male dog breeder with a history of rheumatoid arthritis, bilateral hip arthroplasties, and non-ischemic cardiomyopathy with a heart transplant 10 years ago presented with a three month history of progressive left hip pain and frank purulence on hip aspiration. He underwent irrigation and debridement of the left hip and one-stage revision with hardware exchange. Although gram stain and culture from synovial fluid and intraoperative cultures were initially negative, anaerobic cultures from tissue specimens later grew a spiral-shaped gram-negative rod, identified as Anaerobiospirillum spp. by 16S rRNA gene sequencing. The patient was treated with ceftriaxone 2 g daily for 6 weeks with a good response to treatment. A similar organism was unable to be isolated from culture of 2 of the patient’s dogs, however, they were thought to be the most likely source of his infection. Conclusion Anaerobiospirillum spp. should be considered in immunocompromised patients with exposure to dogs or cats who present with bacteremia, gastrointestinal infection, pyomyositis, or prosthetic joint infections, especially in cases of culture-negative or with anaerobic culture growth.
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Affiliation(s)
- Gregory R Madden
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia Health System, P.O. Box 800473, Charlottesville, VA, 22908-0473, USA.
| | - Melinda D Poulter
- Clinical Microbiology Laboratory. Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael P Crawford
- Clinical Microbiology Laboratory. Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel S Wilson
- Clinical Microbiology Laboratory. Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Gerald R Donowitz
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia Health System, P.O. Box 800473, Charlottesville, VA, 22908-0473, USA
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Epstein DJ, McCullough K. Epithelial tissue cut‐out following needle insertion into a joint: a potential complication during arthroscopy. ANZ J Surg 2019; 89:557-561. [DOI: 10.1111/ans.15131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/19/2019] [Accepted: 01/30/2019] [Indexed: 11/29/2022]
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Risk factors and clinical characteristics of deep knee infection in patients with intra-articular injections: A matched retrospective cohort analysis. Semin Arthritis Rheum 2018; 47:911-916. [DOI: 10.1016/j.semarthrit.2017.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 12/31/2022]
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Liu K, Ye L, Sun W, Hao L, Luo Y, Chen J. Does Use of Lidocaine Affect Culture of Synovial Fluid Obtained to Diagnose Periprosthetic Joint Infection (PJI)? An In Vitro Study. Med Sci Monit 2018; 24:448-452. [PMID: 29360804 PMCID: PMC5791422 DOI: 10.12659/msm.908585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Synovial fluid culture (SFC) is recommended as one of the major diagnostic criteria by the Musculoskeletal Infection Society (MSIS) for diagnosing periprosthetic joint infection (PJI). Local anesthetic agents are used for anesthesia and analgesia in some clinical settings to relieve pain. As a local anesthetic, lidocaine is safely used in arthrocentesis to obtain synovial fluid. The goal of this study was to determine if infiltration anesthesia with additive-free lidocaine 2% has antibacterial effects that might interfere with subsequent SFC. Material/Methods Eight isolates of reference strains of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Streptococcus pyogenes, and Candida albicans were incubated on the plates. Each bacterial suspension was formed by 50-fold dilution before the test lidocaine 2% was added. For each strain, bacterial suspension was divided into 2 groups (5 samples each) exposed either lidocaine 2% or sterile non-bacteriostatic 0.45% saline. The antimicrobial property of lidocaine 2% was determined by measuring the bacterial density on agar plates incubated for 24 h and comparing it with controls unexposed to lidocaine 2%. Results Exposure to lidocaine 2% negatively affected microbial viability in vitro. Of the lidocaine 2% exposure, reference strains but no Streptococcus pyogenes strain resulted in fewer colony-forming units compared with the sterile saline control. The antibacterial property of lidocaine 2% appears to affect the ability to culture the organism in synovial fluid. Conclusions Lidocaine 2% has strong antimicrobial activities against some commonly encountered bacterial strains in PJI. As a result, infiltration anesthesia with additive-free lidocaine 2% before the arthrocentesis procedure may affect the results of SFC. To further evaluate its potential antibacterial usefulness in clinical applications, studies are needed to assess the ability of lidocaine to reduce the risk of iatrogenic infections.
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Affiliation(s)
- Kan Liu
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Liyan Ye
- Department of Clinical Microbiology, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Wei Sun
- Intensive Care Unit, Nanyuan Hospital, Beijing, China (mainland)
| | - Libo Hao
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Yanping Luo
- Department of Clinical Microbiology, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Jiying Chen
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
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