Introduction. Adhesive capsulitis is a common condition causing painful limitation of shoulder movements. Hydrodistension is one of the techniques, is well recognised and has shown good outcomes. However, the results of hydro distension release in secondary adhesive capsulitis are not clear. Patients and Methods. This is a retrospective study on patients undergoing hydro distension release. Patients who had any surgical intervention were classed as secondary whilst the rest were included in the primary group. The hydro distension is a standard technique where in the senior author locates the gleno humeral joint using radio opaque dye, followed by injection of 20 mls 0.5% L-bupivacaine and 80 mg of Triamcinolone, this is followed by use of 60 mls saline to perform the hydro distension. Results. We included 86 shoulders in 80 patients who underwent the procedure. There were 46 females and 34 males, with average age of 51.07 years (range 35 – 75). Left side was involved in 42 shoulders and right in 44. 25 patients showed associated risk factors of which 17 patients had diabetes, 12 had hypercholesterolemia and 5 had underactive thyroid. 65 of the shoulders were in the primary group whilst 21 in the secondary group. In the secondary group the procedures included 8 arthroscopic subacromial decompression with ACJ excision, 7 had rotator cuff repairs, 4 had biceps labral procedure and 2 ORIF clavicle. 3/21 patients required further intervention in secondary group, whilst 10/65 in the primary group required further intervention. Patients who have history of inflammatory arthritides were found to have higher incidence of revision surgery and poorer outcomes. 85% patients in both groups had improvement in their function and range of movements and were happy with the outcome. Conclusion. Hydrodistension provides safe and predictive results in both primary and secondary adhesive capsulitis and should be considered as an option before any invasive procedure

Local infiltration analgesia (LIA) is promoted as an effective treatment modality for pain control after total knee arthroplasty (TKA) (1). A mixture of drugs is used to provide a multimodal analgesic effect. Previous studies reported that the use of these drugs is safe. After we carefully implemented a LIA study protocol in our practice, concerns raised about patient safety with probably higher infection rates. This forced us to perform an interim analysis after the first 58 cases. 58 patients underwent a unilateral TKA with a standardised LIA protocol (2), which consisted of a mixture of ropivacaine, epinephrine, and triamcinolone acetonide. Complications, knee function and patient satisfaction scores were prospectively recorded during regular outpatient control. Four patients (6.9%) presented with signs of periprosthetic joint infection (PJI) within two months after surgery. Baseline characteristics were similar between the infected and non infected group. All infections were treated with debridement and retention, and antimicrobial treatment was started. One patient who suffered an infection died during followup. At two years followup all implants could be retained. Knee function and KSS score were acceptable for the patients who suffered PJI. There is no consensus on the combination of drugs used for LIA. The application of corticosteroids in LIA is reported to be safe (3), but arguable results about the injection of local corticosteroids around knee arthroplasty surgery in the past have raised suspicion in literature (4). Combined with our unacceptable high rate of PJI, we believe that the current body of evidence, with small heterogeneous series, does not support the safe use of corticosteroids in LIA

Introduction. Total knee arthroplasty is a painful operation. Peri-articular local anesthetic injections reduce post-operative pain and assist recovery. It is inconclusive whether intra-operative injections of peri-articular corticosteroids are of benefit. Clinical Question: In patients with osteoarthritis who are undergoing TKA, does the addition of high or low dose corticosteroid to peri-articular injections of local anesthetic and adrenaline improve post-operative pain and range of motion?. Methods. A prospective, randomized, double-blinded study was undertaken to assess the efficacy of adding peri-articular corticosteroids to intra-operative, peri-articular high volume local anaesthetic in post-operative pain management following TKA. 127 patients were randomised into three groups receiving local anaesthetic alone (control) or either low dose (40 mg) or high dose (80 mg) peri-articular corticosteroid plus local anaesthetic. Primary outcomes included ROM and visual analog pain scores (VAS). Pain was defined as the worst pain lasting for more than 20 minutes, measured at both rest (RVAS) and during activity (AVAS). Results. There were no significant between-group differences for age, body mass index (BMI), pre-operative ROM or pre-operative pain scores. There were no statistically significant differences in primary or secondary outcomes between the groups. This was the case at all time points. Analysis of non-significant trends demonstrated a 17.7% reduction in RVAS between the control group and high dose steroid group at 12-weeks. This trend was also apparent at 2 and 6 weeks. There was no trend towards decreased total morphine equivalents (or any other secondary outcome) between the control and high dose groups. Discussion. Corticosteroids have been postulated to facilitate post-operative ROM and reduce pain after TKA. However we were unable to show any significant clinical effect of peri-articular triamcinolone acetate at two different dosages. While it appears that corticosteroids are safe to administer in a select patient population, the results of this paper do not suggest a benefit in TKA

Aims

To describe the incidence of adverse clinical outcomes related to COVID-19 infection following corticosteroid injections (CSI) during the COVID-19 pandemic. To describe the incidence of positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) testing, positive SARS-COV2 IgG antibody testing or positive imaging findings following CSI at our institution during the COVID-19 pandemic.

Drug therapy forms an integral part of the management of many orthopaedic conditions. However, many medicines can produce serious adverse reactions if prescribed inappropriately, either alone or in combination with other drugs. Often these hazards are not appreciated. In response to this, the European Union recently issued legislation regarding safety measures which member states must adopt to minimise the risk of errors of medication.

In March 2014 the Medicines and Healthcare products Regulatory Agency and NHS England released a Patient Safety Alert initiative focussed on errors of medication. There have been similar initiatives in the United States under the auspices of The National Coordinating Council for Medication Error and The Joint Commission on the Accreditation of Healthcare Organizations. These initiatives have highlighted the importance of informing and educating clinicians.

Here, we discuss common drug interactions and contra-indications in orthopaedic practice. This is germane to safe and effective clinical care.

Cite this article: Bone Joint J 2015;97-B:434–41.