Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08-2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12-3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.

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Painful total knee replacement (TKR) without an obvious underlying identifiable pathology is not uncommon. Dissatisfaction after TKR can be up to 20%. Different treatment modalities, including non-operative and operative procedures, have been described in the literature. Radiofrequency ablation of genicular nerves (GNRFA) is emerging as a newer treatment modality for painful TKR without an obvious underlying identifiable pathology. Despite a modest number of publications demonstrating the usefulness of GNRFA in managing pain in knee osteoarthritis, the efficacy of GNRFA has not been completely established in the management of residual pain after TKR. This systematic review aimed to analyze all published studies (nine studies) on GNRFA as an option to manage residual pain after TKR. Based on this current systematic review, we noted that GNRFA is a modality to treat post residual pain and patients can anticipate improvement in pain up to three months with minimal complications. This article provides an overview of the currently available knowledge and techniques employed for this procedure, as well as the expected outcome and safety profile of GNRFA in painful TKR.

Background: Patients with Parkinson disease (PD) undergoing total knee arthroplasty (TKA) can present with a unique subset of challenges during their hospital stay. The literature is limited to single-center studies with a small number of patients. This study was aimed to analyze the inpatient complications, length of stay (LOS), and cost of care (COC) associated after TKA with PD over 4 years (2016 to 2019). Methods: In this retrospective cohort study, we used National Inpatient Sample (NIS) database data from 2016 to 2019 and compared in-hospital complications, LOS, and COC among patients undergoing TKA with and without PD. Results: The National Inpatient Sample database is used to identify 558,371 patients (555,289 without PD and 3,082 with PD) who underwent TKA. After propensity-matching, there was an increased incidence of blood loss anemia (PD group 22.3%, control group 13.5%, P # 0.01), periprosthetic dislocations (1.5% in PD group, 0.4% in control group, P , 0.001), and periprosthetic mechanical complications including but not limited to periprosthetic fractures, knee dislocations, patellar maltracking, and subluxations (1.1% in PD group, 0.6% in control group, P = 0.024) in the PD group. The other inhospital complications including mortality, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, and wound dehiscence showed no notable differences. The average total incurred charges for the PD group were higher, with a mean of $67,581.58 (SD $44,554.64), than that in the control group, with a mean of $64,795.51 (SD $45,841.25) (P , 0.001). The average LOS was higher in the PD group with a mean of 2.7 days (SD = 1.93) compared with the control group (mean = 2.3, SD = 1.73 days, P , 0.001).

Polyethylene (PE) is the key component of total knee replacement (TKR). The wear of polyethylene, a common cause of revision surgeries, depends on multiple factors. The mechanical properties, wear characteristics, and oxidative resistance of PE can be manipulated by the techniques of processing, sterilization, and packaging methods. This article describes the making of conventional and cross-linked poly, packaging, sterilization, processing techniques, and a summary of commercially available plastics and their rationale in TKR including the latest advances.

IntroductionThe surgical treatment of humeral shaft atrophic, gap nonunion following failed surgical fixation is challenging. We intended to evaluate the surgical outcome of failed fixation of humeral shaft atrophic, gap nonunions using locking compression plate (LCP) and autologous nonvascularized fibular graft (ANVFG) and autologous iliac crest bone graft (AICBG). MethodsThrough our database search between 2015 and 2018, we identified 12 patients with humeral shaft atrophic, gap nonunions with failed surgical fixation underwent open reduction and internal fixation using LCP with autologous fibula graft and iliac crest cancellous bone graft. ResultsWe have followed all twelve patients for a minimum period of 24 months. All patients had radiological and clinical union with a mean time to union of 17 weeks. In one case superficial surgical site infection was noted and successfully treated with intravenous antibiotics, and in another, transient peroneal nerve palsy was identified and resolved in six months. ConclusionLCP with ANVFG and AICBG is a reliable option for "complex" diaphyseal humerus atrophic and gap non unions, especially with significant bone loss. This construct provides mechanical stability and supports biological healing in these complex fractures.

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An 81-year-old male patient who underwent a Medacta GMK sphere kinematically aligned (KA) total knee arthroplasty (TKA) for end-stage knee osteoarthritis presented with a dislocated medial pivot (MP) tibia polyethylene (PE) insert on routine six-week postoperative x-rays. The patient presented asymptomatic with a normal range of motion. Dissociation of a fixed-bearing (FB) PE implant is an uncommon complication after TKA. There are only a few cases reported in the literature. We report for the first time a case of nontraumatic dissociation of MP PE from the tibial baseplate in a KA TKA in an asymptomatic patient but identified on routine postoperative radiographs.