Risk analysis of periprosthetic knee joint infection (PJI) in total knee arthroplasty after preoperative corticosteroid injection: a systematic review : A study performed by the Early-Osteoarthritis group of ESSKA-European Knee Associates section.

PURPOSE: Intra-articular corticosteroid injection is widely used for symptomatic relief of knee osteoarthritis. However, if pain is not improved which consequences a total knee arthroplasty (TKA), there is a potential risk of post-operative periprosthetic joint infection (PJI). The aim of this study is to investigate whether the use of preoperative intra-articular corticosteroid injection increases the risk of PJI and to investigate a time frame in which the risk of subsequent infection is significantly increased. METHODS: A systematic search was performed in PubMed (Medline), Scopus, and the Cochrane Library. Inclusion criteria were original studies investigating the rate of PJI in patients receiving pre-operative intra-articular corticosteroid injection compared to controls. RESULTS: A total of 380 unique articles were screened. Six studies met the inclusion criteria with 255,627 patients in total. Overall, no statistical significance was observed in the intra-articular infection rate in corticosteroid compared to controls groups. However, intra-articular corticosteroid injections within 3 months prior to TKA were associated with a significantly increased risk of infection (OR: 1.52, 95% CI 1.37-1.67, p < 0.01); this was not observed in the 6 month period (OR: 1.05, 95% CI 0.80-1.39, p = 0.72). CONCLUSIONS: Performing an intra-articular corticosteroid injection within 3 months prior to TKA is associated with a significantly increased risk of PJI. The current evidence supports the safe use of intra-articular corticosteroid injection more than 6 months before TKA. However, additional studies are needed to clarify the risk of PJI after TKA implantation between 3 and 6 months after the last corticoid injection. LEVEL OF EVIDENCE: IV.

Herida crónica digital: ¿quiste epidermoide, osteomielitis o ambos? Presentación de dos casos clínicos y revisión de la literatura / Chronic digital wound: epidermoid cyst, osteomyelitis or both? Presentation of two clinical cases and review of the literature

Resumen: Introducción: ante una herida crónica a nivel digital se plantea el diagnóstico diferencial entre osteomielitis o tumor primario. No es infrecuente la coexistencia entre osteomielitis y quiste óseo epidermoide. Material y métodos: en este artículo describimos dos casos de quistes epidermoides en falange distal de la mano asociados a osteomielitis y se presenta una revisión de la literatura. Resultados: tanto la osteomielitis como el quiste óseo epidermoide se han relacionado con la presencia de un traumatismo previo en el sitio de la lesión, alteraciones ungueales y signos flogóticos crónicos, por lo que es importante llegar a un diagnóstico certero mediante un estudio anatomopatológico y realizar un buen desbridamiento quirúrgico que asegure la curación de ambas entidades. Conclusiones: el desbridamiento quirúrgico asociado a curetaje y relleno del defecto óseo con sustituto óseo por medio de antibiótico es una buena opción terapéutica en el tratamiento de estas lesiones.

Abstract: Introduction: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon. Material and methods: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented. Results: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities. Conclusions: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.

[Chronic digital wound: epidermoid cyst, osteomyelitis or both? Presentation of two clinical cases and review of the literature]. / Herida crónica digital: ¿quiste epidermoide, osteomielitis o ambos? Presentación de dos casos clínicos y revisión de la literatura.

INTRODUCTION: when faced with a chronic digital injury, the differential diagnosis between osteomyelitis or primary tumor is raised. Coexistence between osteomyelitis and epidermoid bone cyst is not uncommon. MATERIAL AND METHODS: in this article, we describe two cases of epidermoid cysts in distal phalanx of the hand associated with osteomyelitis and a review of the literature is presented. RESULTS: both osteomyelitis and epidermoid bone cyst have been related to the presence of previous trauma at the site of the lesion, nail alterations and chronic phlogotic signs, so it is important to reach a diagnosis of certainty through an anatomopathological study and to perform a good surgical debridement to ensure the healing of both entities. CONCLUSIONS: surgical debridement associated with curettage and filling of the bone defect with bone substitute with antibiotic is a good therapeutic option in the treatment of these lesions.

INTRODUCCIÓN: ante una herida crónica a nivel digital se plantea el diagnóstico diferencial entre osteomielitis o tumor primario. No es infrecuente la coexistencia entre osteomielitis y quiste óseo epidermoide. MATERIAL Y MÉTODOS: en este artículo describimos dos casos de quistes epidermoides en falange distal de la mano asociados a osteomielitis y se presenta una revisión de la literatura. RESULTADOS: tanto la osteomielitis como el quiste óseo epidermoide se han relacionado con la presencia de un traumatismo previo en el sitio de la lesión, alteraciones ungueales y signos flogóticos crónicos, por lo que es importante llegar a un diagnóstico certero mediante un estudio anatomopatológico y realizar un buen desbridamiento quirúrgico que asegure la curación de ambas entidades. CONCLUSIONES: el desbridamiento quirúrgico asociado a curetaje y relleno del defecto óseo con sustituto óseo por medio de antibiótico es una buena opción terapéutica en el tratamiento de estas lesiones.

"Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)-International Committee American Association of Hip and Knee Surgeons (AAHKS)-Arthroplasty Society in Asia (ASIA) survey of members".

PURPOSE: Periprosthetic joint infections (PJIs) represent a devastating consequence of total joint arthroplasty. The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying differences in arthroplasty surgeons' use of various PJI prevention measures to provide clinical recommendations to reduce PJI incidence. METHODS: A prospective Microsoft Forms online survey was distributed among EKA, AAHKS International Committee, and ASIA members and their affiliated arthroplasty surgeons. The survey consisted of 20 single and multiple response questions focused on PJI prevention strategies at three perioperative periods: preoperatively, intraoperatively, and postoperatively. RESULTS: Three hundred and ninety-four arthroplasty surgeons from 6 different continents completed the survey. Preoperative: (A) PJI Risk Stratification: 40.6% routinely set thresholds (e.g., BMI, HgbA1C) to be met to qualify for surgery, 36.5% only review past medical history; 9.1% use machine learning to personalize PJI risk; (B) BMI limit: 36% no limit; 15.4% BMI < 35; 30.9% BMI < 40; 17.2% BMI < 45; (C) Nutritional status: 55.3% do not screen; among those who screen their patients (44.7%), albumin is the single most used marker (86.3%); (D) Hyperglycemia/Diabetes: 83.3% check this comorbidity; 88.1% use HgbA1C as single best screening test; (E) MRSA nasal colonization: 63.7% do not test; 28.9% test all patients; 7.4% test selectively. Intraoperative: (A) Antibiotic prophylaxis in high-risk patients: 43.4% use single antibiotic for 24 h; 21.3% use double antibiotic for 24 h; 14.2% use single/double antibiotic for 7 days postoperatively; (B) Skin-cleansing: 68.7% at home (45.6% chlorhexidine sponge; 11.9% clippers); (C) Intraoperative skin disinfection: 46.9% single chlorhexidine; 25% double chlorhexidine-povidone-iodine;15.4% single povidone-iodine; (D) Tranexamic acid (TXA) to reduce bleeding/SSI: 96% yes (51% double IV dose, 35.2% single IV dose, 23.6% intra-articular injection); (E) Surgical suction drain: 52% do not use drains; 19.7% use a drain < 24 h; (F) Intra-articular lavage: 64.9% use only saline; 28.1% use dilute povidone-iodine; (G) Antibiotic local delivery to prevent PJI: 82.4% use antibiotic-added cement. Postoperative: (A) Routine monitoring of PJI serologic markers: 42% only in symptomatic patients; 34.2% do not; 20.8% in all patients; (B) Serologic markers to rule in/out PJI: 95.9% CRP; 71% SEDRATE; 60.6% WBC; (C) Synovial fluid test to rule in/out PJI: 79.6% culture/sensitivity; 69.5% WBC count; 31.4% CRP. CONCLUSIONS: This survey demonstrated that notable differences still exist in the application of PJI preventive measures across different geographic areas: Optimizing the patient preoperatively and applying multimodal intraoperative strategies represent newer, clinically relevant steps in the effort to reduce the burden of PJI. More uniform guidelines still need to be produced from international scientific societies in order facilitate a more comprehensive approach to this devastating complication. LEVEL OF EVIDENCE: IV.

[Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain]. / Osteosíntesis sintomática en fractura de calcáneo: colonización de implante como causa del dolor.

Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Osteosíntesis sintomática en fractura de calcáneo: colonización de implante como causa del dolor / Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain

Resumen: La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Abstract: Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

Controversias en fracturas de tobillo: ¿es diferente la visión del especialista en pie y tobillo? / Ankle fracture controversies: do the foot and ankle specialists have a different vision?

Objetivo. Analizar las diferencias en el manejo de las fracturas de tobillo entre cirujanos ortopédicos/traumatólogos y especialistas en enfermedad de pie y tobillo. Material y método. Se realizó una encuesta vía correo electrónico que planteaba cuestiones controvertidas a propósito del análisis de 5 casos clínicos de diferentes fracturas de tobillo a cirujanos ortopédicos del país. Resultados. Setenta y dos cirujanos respondieron la encuesta (tasa de respuesta del 24,2%): 37 especialistas en pie y tobillo y 35 cirujanos ortopédicos no especialistas. En el caso de la fractura trimaleolar, el 40,5% de los especialistas solicitarían una tomografía computarizada frente al 14% de los no especialistas (p=0,01). El 94% de todos los que respondieron sintetizaría el maléolo posterior; el 91% de los no especialistas, con tornillos vía anteroposterior, mientras que el 43% de los especialistas utilizarían la vía posteroanterior, bien con placa o con tornillos (p=0,006). No se hallaron diferencias entre grupos en el tratamiento de las lesiones sindesmales (p>0,05). En las fracturas transindesmales (B de Weber) con signos de inestabilidad medial, el 54% de los no especialistas revisarían el ligamento lateral interno frente a solo el 32% de los especialistas (p=0,06). Conclusiones. Los especialistas en pie y tobillo solicitan más pruebas complementarias para el diagnóstico de las fracturas de tobillo. A su vez, utilizan una mayor diversidad de técnicas quirúrgicas en la síntesis de los maléolos posterior (vía posterior-placas) y medial (cerclajes). Por último, indican una menor tasa de revisión del ligamento lateral interno (AU)

Objective. To analyse the differences in the management of ankle fractures between orthopaedic/trauma surgeons and foot and ankle specialists. Material and method. An e-mail survey was performed asking some of the country's orthopaedic surgeons controversial questions regarding the analysis of 5 clinical cases of different ankle fractures. Results. Seventy-two surgeons responded to the questionnaire (response rate of 24.2%): 37 foot and ankle specialists and 35 non-specialist orthopaedic surgeons. For trimalleolar fracture, 40.5% of the specialists would request a computed tomography scan compared to 14% of the non-specialists (P=.01). Ninety-four percent of all the respondents would synthesise the posterior malleolus; 91% of the non-specialists would use an antero-posterior approach, either with a plate or with screws (P=.006). No differences were found between groups in the treatment of syndesmotic injuries (P>.05). For trans-syndesmotic fracture (Weber B) with signs of medial instability, 54% of the non-specialists would revise the internal lateral ligament compared to only 32% of the specialists (P=.06). Conclusions. The foot and ankle specialists ask for more complementary tests to diagnose ankle fractures. In turn, they use a greater diversity of surgical techniques in synthesis of the posterior malleolus (posterior plate) and the medial malleolus (cerclage wires). Finally, they indicated a lower revision rate of the internal lateral ligament (AU)

Ankle fracture controversies: Do the foot and ankle specialists have a different vision? / Controversias en fracturas de tobillo: ¿es diferente la visión del especialista en pie y tobillo?

OBJECTIVE: To analyse the differences in the management of ankle fractures between orthopaedic/trauma surgeons and foot and ankle specialists. MATERIAL AND METHOD: An e-mail survey was performed asking some of the country's orthopaedic surgeons controversial questions regarding the analysis of 5 clinical cases of different ankle fractures. RESULTS: Seventy-two surgeons responded to the questionnaire (response rate of 24.2%): 37 foot and ankle specialists and 35 non-specialist orthopaedic surgeons. For trimalleolar fracture, 40.5% of the specialists would request a computed tomography scan compared to 14% of the non-specialists (P=.01). Ninety-four percent of all the respondents would synthesise the posterior malleolus; 91% of the non-specialists would use an antero-posterior approach, either with a plate or with screws (P=.006). No differences were found between groups in the treatment of syndesmotic injuries (P>.05). For trans-syndesmotic fracture (Weber B) with signs of medial instability, 54% of the non-specialists would revise the internal lateral ligament compared to only 32% of the specialists (P=.06). CONCLUSIONS: The foot and ankle specialists ask for more complementary tests to diagnose ankle fractures. In turn, they use a greater diversity of surgical techniques in synthesis of the posterior malleolus (posterior plate) and the medial malleolus (cerclage wires). Finally, they indicated a lower revision rate of the internal lateral ligament.

Impacto del hundimiento en vástagos de revisión rectos y curvos modulares en cirugía de revisión de cadera / The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery

El hundimiento protésico es una de las potenciales complicaciones de los vástagos femorales de anclaje diafisario no cementado en las cirugías de revisión protésica, lo cual puede afectar a la estabilidad y a la osteointegración del componente. En este estudio retrospectivo evaluamos los resultados al año y a los 5 años (especialmente el hundimiento y la relevancia clínica) de 40 revisiones de vástago femoral consecutivas, comparando 2 vástagos de revisión modulares no cementados rectos vs. curvos, con 20 pacientes en cada grupo. No se observó ningún fracaso mecánico y se obtuvo una mejoría en cuanto a resultados funcionales en la totalidad de los casos. El hundimiento radiológico medio fue de 9,9±4,9mm (p=0,076); 14 pacientes (35%) tuvieron ≥10mm de hundimiento, con un máximo de 22mm en un caso. Nuestros resultados son similares a las series publicadas en la literatura, sin manifestaciones clínicas a corto-medio plazo ni incremento del número de complicaciones o aflojamiento del vástago en ninguno de los 2 grupos. No se observaron diferencias en cuanto al hundimiento protésico al año y a los 5 años posteriores a la cirugía entre los 2 tipos de vástagos (AU)

Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems (AU)

The impact of subsidence on straight and curved modular cementless revision stems in hip revision surgery. / Impacto del hundimiento en vástagos de revisión rectos y curvos modulares en cirugía de revisión de cadera.

Subsidence is one of the potential complications in femoral stem revision total hip arthroplasty surgery, and can affect stability and osseointegration. A retrospective study was conducted on the outcomes at one year and 5 years (specifically subsidence and clinical relevance) of 40 consecutive femoral total hip arthroplasty revisions, comparing two modular cementless revision stems, Straight vs. Curved, with 20 patients in each group. No mechanical failure was observed, and there was an improvement in functional outcomes. Mean radiological subsidence was 9.9±4.9mm (straight=10.75mm vs. curved=9.03mm), with no statistically significant difference between groups (p=0,076). Fourteen patients (35%) had ≥10mm of subsidence, up to a maximum of 22mm. The subsidence found in this study is similar to published series, with no short-term clinical manifestations, or an increased number of complications or stem loosening in either the Straight or Curved group. No differences in subsidence were observed at one year and 5 years after surgery between the 2 types of stems.

¿Pueden influir las variables epidemiológicas el resultado a los 2 años de una cirugía por enfermedad lumbar degenerativa en términos de calidad de vida, discapacidad y dolor postoperatorio? / Can epidemiological factors affect the 2-year outcomes after surgery for degenerative lumbar disease in terms of quality of life, disability and post-surgical pain?

Objetivo: Evaluar si los factores epidemiológicos afectan a los resultados de la cirugía por enfermedad lumbar degenerativa en términos de calidad de vida, discapacidad y dolor crónico. Material y método: Doscientos sesenta y tres pacientes intervenidos por afección lumbar degenerativa fueron incluidos en el estudio (2005-2008). Variables epidemiológicas: edad, género, situación laboral y comorbilidad. Se completaron en el preoperatorio y 2 años tras la cirugía el Medical Outcomes Study Short Form-36 version 2, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI) y EVA para dolor lumbar y ciático. En el análisis de los datos, se evaluó la correlación entre variables epidemiológicas y el cambio en los resultados de los cuestionarios, así como, la existencia de factores pronósticos independientes. Resultados: Edad media 54,00 años (22-86); 131 mujeres (49,8%); 42 pérdidas de seguimiento (16%). Se observaron correlaciones significativas (p < 0,05) entre la edad, el género, la comorbilidad, la incapacidad laboral permanente y el dolor preoperatorio con el cambio del ODI, el COMI, los componentes de salud física y mental y las EVA de lumbar y ciático. El análisis de regresión lineal muestra a las ILP y la edad como variables predictoras del cambio de la discapacidad (β = 14,146; IC del 95%, 9,09-29,58; p < 0,01, y β = 0,334; IC del 95%, 0,40-0,98, p < 0,05, respectivamente) y de la calidad de vida (β = −8,568; IC del 95%, −14,88, −2,26; p < 0,01 y β = −0,228, IC del 95%, −0,40, −0,06, p < 0,05, respectivamente). Conclusión: Según nuestros resultados, hemos de considerar al aumento de la edad y la incapacidad laboral permanente como factores epidemiológicos predictores negativos de los resultados tras cirugía por patología lumbar degenerativa (AU)

Purpose: To evaluate the influence of epidemiological factors on the outcomes of surgery for degenerative lumbar disease in terms of quality of life, disability and chronic pain. Material and method: A total of 263 patients who received surgery for degenerative lumbar disease (2005-2008) were included in the study. The epidemiological data collected were age, gender, employment status, and co-morbidity. The SF-36, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), and VAS score for lumbar and sciatic pain were measure before and 2 years after surgery. The correlation between epidemiological data and questionnaire results, as well as any independent prognostic factors, were assessed in the data analysis. Results: The mean age of the patients was 54.0 years (22-86), and 131 were female (49.8%). There were 42 (16%) lost to follow-up. Statistically significant correlations (P < 0.05) were observed between age, gender, co-morbidity, permanent sick leave, and pre-operative pain with changes in the ODI, COMI, physical and SF-36 mental scales, and lumbar and sciatic VAS. Linear regression analysis showed permanent sick leave and age as predictive factors of disability (β = 14.146; 95% CI : 9.09-29.58; P < 0.01 and β = 0.334; 95% CI: 0.40-0.98, P < 0.05, respectively), and change in quality of life (β = −8.568; 95% CI: −14.88 to −2.26; P < 0.01 and β = −0.228, 95% CI: −0.40 to −0.06, P < 0.05, respectively). Conclusion: Based on our findings, age and permanent sick leave have to be considered as negative epidemiologic predictive factors of the outcome of degenerative lumbar disease surgery (AU)

[Can epidemiological factors affect the 2-year outcomes after surgery for degenerative lumbar disease in terms of quality of life, disability and post-surgical pain?]. / Pueden influir las variables epidemiológicas el resultado a los 2 años de una cirugía por enfermedad lumbar degenerativa en términos de calidad de vida, discapacidad y dolor postoperatorio?

PURPOSE: To evaluate the influence of epidemiological factors on the outcomes of surgery for degenerative lumbar disease in terms of quality of life, disability and chronic pain. MATERIAL AND METHOD: A total of 263 patients who received surgery for degenerative lumbar disease (2005-2008) were included in the study. The epidemiological data collected were age, gender, employment status, and co-morbidity. The SF-36, Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), and VAS score for lumbar and sciatic pain were measure before and 2 years after surgery. The correlation between epidemiological data and questionnaire results, as well as any independent prognostic factors, were assessed in the data analysis. RESULTS: The mean age of the patients was 54.0 years (22-86), and 131 were female (49.8%). There were 42 (16%) lost to follow-up. Statistically significant correlations (P<.05) were observed between age, gender, co-morbidity, permanent sick leave, and pre-operative pain with changes in the ODI, COMI, physical and SF-36 mental scales, and lumbar and sciatic VAS. Linear regression analysis showed permanent sick leave and age as predictive factors of disability (ß=14.146; 95% CI: 9.09 - 29.58; P<.01 and ß=0.334; 95% CI: 0.40 - 0.98, P<.05, respectively), and change in quality of life (ß=-8.568; 95% CI: -14.88 - -2.26; p<.01 and ß=-0.228, IC 95% CI: -0.40 - -0.06, P<.05, respectively). CONCLUSION: Based on our findings, age and permanent sick leave have to be considered as negative epidemiologic predictive factors of the outcome of degenerative lumbar disease surgery.