Acetabular bone loss is a problem in primary and revision Total Hip Joint Replacement (THJR). Impaction bone grafting is one method of dealing with this problem. We looked at the results of two surgeons who use this method at North Shore Hospital, Auckland.

A retrospective study was carried out on all patients who had acetabular impaction bone grafting carried out as part of THJR, whether primary or revision. All operations were performed by two surgeons, Mr Rob Sharp and Mr Bill Farrington. Patients were assessed in clinic at varying time intervals post grafting, and were functionally scored.

33 patients underwent impaction grafting, a total of 35 acetabular grafts. Of these the male to female ratio was 16:17, and the mean age range was 46–82 years. Average Harris hip score was 79 (Min 54 Max 95), and the average Oxford score was 39 (min 13 Max 48). There was one failure, 3 dislocations, and1 sciatic nerve palsy.

Impaction bone grafting is one method, which can be utilised to reconstruct acetabular bone loss, with the additional advantage of restoring bone stock. We found high rates of patient satisfaction, and a low failure rate.

Aim: To present the features of PVL toxin positive staphylococcus causing osteomyelitis in children and its management.

Method: Two cases of PVL MSSA osteomyelitis have presented to our institute within the last six months. The first, a 15 year old boy presented with an abscess and surrounding cellulitis on the lower right leg following a skin abrasion sustained whilst playing football. He was recognized as being systemically unwell with extremely elevated inflammatory markers. Radiographic investigations demonstrated osteomyelitis.

The second case was that of an 11 year old girl who developed cellulitis of the lower thigh, but was not as systemically unwell as the first case. Radiographs again demonstrated osteomyelitis.

Results: Both children were treated with intravenous antibiotics and supportive measures and made a full recovery.

Conclusions: Panton Valentine Leukocidin (PVL) is a toxic substance produced by some strains of Staphylococcus aureus with an increased ability to cause disease. Although more common in the United States, less than 2% of all S. aureus infections in the UK carry the toxin. PVL can be carried both by MRSA (methicillin resistant) and MSSA (methicillin sensitive) Staphylococcus aureus.

Patients normally present with cellulitis, abscesses, boils and carbuncles. However, on rare occasions, more severe invasive infections result, including septic arthritis, bacteraemia or necrotizing pneumonia.

We feel that osteomyelitis caused by PVL positive MSSA is associated with more severe local disease and a greater systemic inflammatory response than osteomyelitis caused by PVL negative MSSA. Treatment is effective but needs to be initiated promptly to prevent significant complications.

Introduction: Recently there has been a trend for recommending weight bearing 30û ßexion views as the standard view in place of full extension view for the routine radiography of the Knee. It has been shown that this view can pick up more abnormalities and can show a joint space diminution, which cannot be seen on full extension views. It has not been shown by any study that this is not due to the differential thickness of cartilage in different places on femoral condyle thus implying a natural cause rather than pathological process (abnormal wearing of cartilage) of the observed decrease in joint space. So this prospective randomised double blind study was designed. Methods: 22 patients with arthroscopically proven non osteoarthritic knees were included in the study. Knee radiographs were taken in weight bearing full extension and 30û ßexion PA views. The radiographs were randomised and read by a consultant, registrar & senior house ofþcer. Results: Appropriate statistical tests were applied and results analysed. There was up to 2mm difference in the joint space on the two views. Conclusion: The decrease in the joint space if seen on 30û ßexion views as compared to full extension views may be due to the differential thickness of inherent normal cartilage and so is not always due to a pathological process. Based on this a classiþcation was devised to signify the importance of measured differential thickness in the cartilage of femoral condyle.

There have been many reports which suggest that in patients with tibiofemoral osteoarthritis, a reduction in joint space is demonstrated better on weight-bearing radiographs taken with the knee in semiflexion than in full extension. The reduction has been attributed to the loss of articular cartilage in the contact area in a semiflexed arthritic knee. None of these studies have, however, included normal knees. We have therefore undertaken a prospective, double-blind, randomised study in order to evaluate the difference in the joint-space of arthroscopically-proven normal tibiofemoral joints as seen on weight-bearing full-extension and 30° flexion posteroanterior radiographs. Twenty-two knees were evaluated and the results showed that there may be a difference of up to 2 mm in the two views. This difference could be attributed to the inherent differential thickness of the articular cartilage in different areas of the femoral and tibial condyles and a change in the areas of contact between them.