Revision surgery and debridement and implant retention are recognised approaches for managing prosthetic joint infections (PJI) but may not always be indicated. If the patient is unable to have or declines surgery, prolonged suppressive antibiotic therapy (PSAT) is an option. This study aims to define outcomes of PSAT from a single unit. A retrospective study was performed. All cases of PJI involving the hip or knee between 2012 and 2017 were identified from our institutional database and cross referenced with patient notes. One hundred and seventy eight cases were identified. Of these, 23 (12.9%) (10 hips, 13 knees) were treated with PSAT. Infection was diagnosed based on the MSIS criteria in all cases and all cases were managed by a multidisciplinary team which included specialist microbiologists. One case of long term antifungal therapy was additionally identified. Co-morbidity was assessed using the Charlson co-morbidity index. Exacerbations of infection and need for further surgery were recorded.Aim
Method
Instability accounts for one third of revision total hip arthroplasty(rTHA) performed in the United Kingdom. Removal of well-fixed femoral stems in rTHA is challenging with a risk of blood loss and iatrogenic damage to the femur. The Bioball Universal Adaptor (BUA) (Merete, Germany), a modular head neck extension adaptor, provides a mechanism for optimisation of femoral offset, leg length and femoral anteversion. This can avoid the need for femoral stem revision in selected cases. There is a relative paucity of clinical data available with the use of this device. The aim of this study is to present the clinical results and rate of instability following revision with this head neck adaptor at a minimum of two years' follow up.Introduction
Aim
Hip dysplasia represents a wide spectrum of disease, and interest in the treatment of the disorder has increased with the development of newer surgical techniques and a greater understanding of young adult hip disorders. National hospital episode statistics (HES) were studied from 1999 to 2010. This data remains the current best source of information on surgical procedures outside of dedicated registries. Age stratified data was analysed for 7 separately coded operations for the treatment of hip dysplasia. Overall in the paediatric population there were 898 procedures in 2010 compared to 793 procedures in 2000, but with no detectable trend across that period. Equally, there were no great fluctuations in the small numbers of arthroplasty procedures recorded in either the paediatric or adult populations. There was, however, a clear increase in surgery being performed in adult patients. 210 primary pelvic osteotomies were performed in 2010, compared with only 77 in 2000, with a noticeable increase from 2005 onwards. A similar trend in other extra-articular procedures is seen, rising from 2 to 55 per year over the period studied. Overall, the level of surgical intervention has steadily risen from 104 procedures in 2000 to 422 in 2010, representing a fourfold rise in the number of operations being performed for hip dysplasia in the adult population over an 11 year period. The reasons for this are unclear. It may reflect improvements in the ability to diagnose and intervene earlier to prevent disease progression, but further research is also needed to better define the aetiology underlying these cases that present to the hip surgeon later in life.
