We reviewed 231 patients who had undergone total knee replacement with an AGC (Biomet) implant over a period of 2.5 years. After applying exclusion criteria and with some loss to follow-up, there were 144 patients available for study. These were divided into two groups; those who had received intra-articular steroid in the 11 months before surgery and those who had not. There were three deep infections, all of which occurred in patients who had received a steroid injection. The incidence of superficial infection was not significantly different in the two groups. Five patients had undergone investigation for suspected deep infection because of persistent swelling or pain and all of these had received an intra-articular injection pre-operatively. We conclude that the decision to administer intra-articular steroids to a patient who may be a candidate for total knee replacement should not be taken lightly because of a risk of post-operative deep infection.
Study design: Case report. Objective: To report a case of spinal cord infarction after a self-inflicted needle stick injury, following an injection of heroin into the cord. Setting: National spinal injury unit in a Scottish University teaching hospital, Glasgow, UK. Case report: A 20-year-old male, injected street heroin accidentally into the cord through the left side of the neck, leading to sudden loss of power to all four limbs. Initial magnetic resonance imaging scans showed extensive cord oedema and follow-up scans showed signal changes within the anterior horns of the spinal cord in keeping with a cord infarct. Conclusion: Self-inflicted spinal cord injury with a small needle is difficult, but not impossible. Cord infarct as a result of a self-inflicted injury has not been previously reported. The mechanism of the injury resulting in cord infarction is explained by the vascular anatomy of the spinal cord circulation, and this may also explain the residual neurological status of the patient.
In reply to Dr J SilverWe thank Dr Silver for his interest and for drawing our attention to previous papers.In clinical practice we are familiar with the phenomenon of cord oedema and paralysis in street drug users.In the case described we found such a close and instantaneous temporal and anatomical relationship of the injection to the damaged cord that we believe there must have been immediate arterial damage, at the instant of injection.We believe that street Heroin injected peripherally, as described by Dr Silver, is likely to cause myelopathy by a different mechanism.
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