Purpose The goal of this systematic review and meta-analysis was to identify the main risk factors for periprosthetic joint infection (PJI) in patients undergoing total hip or knee arthroplasties. Methods A systematic review was conducted of the potential risk factors for PJI in total hip or total knee arthroplasty. Risk factors were compared and grouped according to demographics, comorbidities, behavior, infections, native joint diseases and other patient-related and procedure-related factors. Meta-analysis (random-efects models) was conducted using odds ratio (OR) and mean diference (MD). Risk of bias (ROBBINS-I) and strength of the evidence (GRADE) were assessed. ResultsThe study included 37 studies (2,470,827 patients). Older age was a protective factor (MD = − 1.18). Male gender (OR 1.34), coagulopathy (3.05), congestive heart failure (2.36), diabetes mellitus (1.80), obesity (1.61), systemic neoplasia (1.57), chronic lung disease (1.52), and hypertension (1.21) increased the risk for PJI. Behavioral risk factors comprised alcohol abuse (2.95), immunosuppressive therapy (2.81), steroid therapies (1.88), and tobacco (1.82). Infectious risk factors included surgical site infections (6.14), postoperative urinary tract infections (2.85), and prior joint infections (2.15). Rheumatoid arthritis, posttraumatic native joint disease, high National Nosocomial Infections Surveillance (NNIS) system surgical patient index score, prior joint operation, American Society of Anesthesiologists score ≥ 3 and obesity were also signiicantly associated with higher risk of PJI. Osteoarthritis and blood transfusion were protective factors. Conclusions The main risk factors for PJI in each category were male gender, coagulopathy, alcohol abuse, surgical site infection (highest score) and high NNIS system surgical patient index score. Protective factors were age, female gender in TKA, osteoarthritis and blood transfusion. Optimization of modiiable risk factors for PJI should be attempted in clinical practice. Level of evidence II.

Objective: To verify the presence of the sedimentation sign in patients with lumbar spinal stenosis (LSS) in comparison to those without LSS. Methods: Retrospective, cross-sectional and descriptive study. Review of the imaging processes of patients with LSS operated between January 1, 2008 and December 31, 2009, comparing with patients without LSS observed in outpatient consultations. Patients were divided into two groups: group I had 34 patients with a diagnosis of LSS. Diagnostic criteria: existence of low back pain and/or neurogenic claudication and/or radiculopathy, associated with an anteroposterior canal diameter of less than 10 mm. Group II had 40 patients observed in outpatient consultations for low back pain without clinical LSS. The canal diameter was measured and the presence of the sedimentation sign between D12 and S1 was verified. Results: A positive sedimentation sign was identified in 31 of the 34 patients in group I (91.2%); only below the stenosis in two of these 31 patients. The sign was not observed in the patients in group II. A statistically significant correlation was observed between the variables "canal diameter" and "presence of sedimentation sign" (p < 0.01) in the group of patients with lumbar spinal stenosis. Conclusion: The diagnosis of LSS is not always easy due to the frequent dissonance between the clinical and imaging findings. The sedimentation sign is positive in patients with LSS between L1 and L5 and can be a valid sign to complement the diagnosis of LSS.Keywords: Lumbar; Roots; Diagnosis; Magnetic resonance spectroscopy; Sedimentation. RESUMO

Objective: Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the influence of cofactors in the grip strength in a sample of the population of our country. Material and Methods: A representative population survey was used as the basis for prediction analyses (n = 296). Intraindividual and interindividual variations of grip strength and their relation to several anthropometric factors were analyzed in a standardized manner for 296 healthy adults (women, n = 140; men, n = 156) aged between 20 and 69 years. We carried in each individual, 5 measurements alternately in each hand, calculating the average value. Cases in which there was a difference of more than 10% of the measurements were excluded. Measurements were done in neutral position of arm, forearm, and wrist with Jamar Hydraulic Hand Dynamometer. We also note the active side, profession, height, weight, and size of the hand. The results were statistically analyzed using SPSS. The sample characterization was performed by frequency analysis. Analysis of variance was used to study the correlation between variables. Results: Mean strength was about 38% less in women (right 26.6 kg; left 25.16 kg) than in men (right 43.13 kg; left 40.65kg). Grip strength peaks at 40 to 49 years of age with an important difference between those with less then 50 years and with more then 50 years old. Anthropometric variables such as hand size or sex showed a positive correlation with grip strength. Body mass index and type of work showed only a partial positive correlation or no correlation with grip strength. Conclusion: Easy-to-measure cofactors such as sex, age, and hand size have a high accurate prediction of normative pinch strength. Body mass index and type of work did not demonstrate significant predictive value. We recommend side adjustment of measured values for intraindividual comparison and inclusion of information regarding anthropometric characteristics, as well as using gender and age-adjusted reference values.

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