Two discrete legal factors enable the surgeon to treat an injured patient the fully informed, autonomous consent of the adult patient with capacity via civil law; and the medical exception to the criminal law. This article discusses current concepts in consent in trauma; and also considers the perhaps less well known medical exception to the Offences against the Person Act 1861, which exempts surgeons from criminal liability as long as they provide ‘proper medical treatment’.

Cite this article: Bone Jt Open 2024;5(7):565–569.

Aim. The purpose of this study is to report the overall infection control rate and prognostic factors associated with acute, hematogenous and chronic PJIs treated with DAIR. Methods. All DAIR procedures performed at 2 institutions from 2009 to 2018 (n=104) were reviewed and numerous data were recorded, including demographics, preoperative laboratory tests, Charleston Comorbidity Index, surgical information and organism culture results. Treatment success was defined according to the criteria reported by Diaz-Ledezma. A multivariable analysis was utilized to identify prognostic factors associated with treatment and a Kaplan-Meier survival analysis was used to depict infection control rate as a function of time. Results. The overall treatment success rate in the current cohort of patients was 67.3% at a median 38.6 (23.5–90.7) months follow-up. Patients with a duration of infectious symptoms greater than 10 days were more likely to fail (P=0.035, odds ratio 8.492, 95% confidence interval 1.159–62.212). There was no difference among acute, hematogenous and chronic infections in terms of failure rate even when time was considered (p=0.161). Conclusion. With careful patient selection, DAIR is a reasonable treatment option for PJI and its use in the setting of chronic infection does not appear to be a contraindication. Performing the DAIR procedure within 10 days of the presentation of symptoms had higher rates of treatment success

Reverse total shoulder arthroplasty (RTSA) has a proven track record as an effective treatment for a variety of rotator cuff deficient conditions. However, glenoid erosion associated with the arthritic component of these conditions can present a challenge for the shoulder arthroplasty surgeon. Options for treatment of glenoid wear include partial reaming with incomplete baseplate seating, bony augmentation using structural or impaction grafting techniques, and augmented baseplates. Augmented components have the advantage of accommodating glenoid deformity with a durable material and also ream less subchondral bone; both of which may offer an advantage over traditional bone grafting. Biomechanical and early clinical studies of augmented glenoid baseplates suggest they are a reasonable treatment option, though posteriorly augmented baseplates have shown better performance than superiorly augmented implants. However, there are no mid- or late-term studies comparing augmented baseplates to bone grafting or partial reaming. We present a live surgical demonstration of RTSA for a patient with advanced glenoid erosion being treated with an augmented glenoid baseplate that can be dialed in the direction of any deformity (superior, posterior, etc.). This versatility allows the surgeon to place the augment in any direction and is not confined to the traditional concepts of glenoid wear in a single vector. Clearly, longer term follow up studies are needed to determine the ultimate effectiveness of these devices in treating glenoid deformity in RTSA

A rare case of malignant transformation of fibrous dysplasia to chondrosarcoma involving the pelvis, treated by hemipelvectomy, was described by our team in a published case report. Twenty-four years later, the patient remains recurrence-free, with a good functional outcome that allows him to be independent in everyday activities and work in full time employment. Functional outcome following hemipelvectomy for pelvic malignancy is an evolving topic, as improved imaging and surgical techniques result in earlier diagnosis and a better overall prognosis. Sarcomas involving the pelvis still represent a challenging topic for surgeons. During the last twenty-four years, there have been some advances in the limb- salvage treatment of pelvic tumours. An internal hemipelvectomy is currently considered to be a reasonable treatment option, with good functional outcomes and achievement of satisfactory tumour clearance margins, in well- selected cases. In all cases however, the main focus should be in the adequate resection of the lesion, followed by restoration of maintenance of stability. We report a fascinating case of a patient who underwent internal hemipelvectomy without reconstruction for chondrosarcomatous transformation of pelvic fibrous dysplasia, with emphasis on the clear surgical resection margins and disease-free status of the patient and satisfactory functional outcome. We support that internal hemipelvectomy is an acceptable treatment option in well- selected cases and can achieve clear tumour resection margins, resulting in long term disease-free results, and a good limb- salvage functional outcome. We believe that joint stability in this patient is mainly a result of preservation of the adductor muscle group, which prevents the hip joint from upward migration and allows the patient to use his left leg for walking

The December 2014 Knee Roundup³⁶⁰ looks at: national guidance on arthroplasty thromboprophylaxis is effective; unicompartmental knee replacement has the edge in terms of short-term complications; stiff knees, timing and manipulation; neuropathic pain and total knee replacement; synovial fluid α-defensin and CRP: a new gold standard in joint infection diagnosis?; how to assess anterior knee pain?; where is the evidence? Five new implants under the spotlight; and a fresh look at ACL reconstruction

The October 2012 Hip & Pelvis Roundup³⁶⁰ looks at: diagnosing the infected hip replacement; whether tranexamic acid has a low complication rate; the relationship between poor cementing technique and early failure of resurfacing; debridement and retention for the infected replacement; triple-tapered stems and bone mineral density; how early discharge can be bad for your sleep; an updated QFracture algorithm to predict the risk of an osteoporotic fracture; and local infiltration analgesia and total hip replacement.

The August 2012 Hip & Pelvis Roundup³⁶⁰ looks at: whether cemented hip replacement might be bad for your health; highly cross-linked polyethylene; iHOT-33 - a new hip outcome measure; hamstring injuries; total hip replacement; stemmed metal-on-metal THR; bipolar hemiarthroplasty, neuromuscular disease and dislocation; the high risk of secondary hemiarthroplasty; and whether we have to repair the labrum after all?